Provider Demographics
NPI:1649288473
Name:ODELL, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:ODELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15400 W 64TH AVE UNIT 9E
Mailing Address - Street 2:SUITE 14
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-6852
Mailing Address - Country:US
Mailing Address - Phone:303-422-3909
Mailing Address - Fax:303-422-2192
Practice Address - Street 1:15400 W 64TH AVE UNIT 9E
Practice Address - Street 2:SUITE 14
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-6852
Practice Address - Country:US
Practice Address - Phone:303-422-3909
Practice Address - Fax:303-422-2192
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO35741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01357417Medicaid
CO015122OtherKAISER COMMERCIAL NUMBER
CO01357417Medicaid
COC519878Medicare PIN
G66434Medicare UPIN
COCOA103441Medicare PIN