Provider Demographics
NPI:1669513628
Name:GUESE, MICHAEL J
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:GUESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E HARVARD AVE
Mailing Address - Street 2:STE 365
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5076
Mailing Address - Country:US
Mailing Address - Phone:303-722-2724
Mailing Address - Fax:303-722-3121
Practice Address - Street 1:850 E HARVARD AVE
Practice Address - Street 2:STE 365
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5076
Practice Address - Country:US
Practice Address - Phone:303-722-2724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01246750Medicaid
CO01246750Medicaid
COEO4744Medicare UPIN