Provider Demographics
NPI:1396871265
Name:MENACHOF, MICHAEL R (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:MENACHOF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:7400 E CRESTLINE CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3656
Mailing Address - Country:US
Mailing Address - Phone:303-792-3242
Mailing Address - Fax:303-792-9403
Practice Address - Street 1:7400 E CRESTLINE CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3656
Practice Address - Country:US
Practice Address - Phone:303-792-3242
Practice Address - Fax:303-792-9403
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO31645207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1396871265OtherNPI
CO01316454Medicaid
CO48138274Medicaid
CO1710065446OtherNPI
COE78603Medicare UPIN
CO01316454Medicaid
CO48138274Medicaid