Provider Demographics
NPI:1720099187
Name:WERTZ, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:WERTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 RIVERBEND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2618
Mailing Address - Country:US
Mailing Address - Phone:303-665-0286
Mailing Address - Fax:303-666-5112
Practice Address - Street 1:4820 RIVERBEND RD STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2618
Practice Address - Country:US
Practice Address - Phone:303-665-0286
Practice Address - Fax:303-666-5112
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30151207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01301514Medicaid
CO01301514Medicaid
COL3228Medicare ID - Type Unspecified