Provider Demographics
NPI:1750421087
Name:BRAZELTON, MICHAEL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:BRAZELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5351 W DORADO PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-0858
Mailing Address - Country:US
Mailing Address - Phone:303-526-7594
Mailing Address - Fax:303-526-7594
Practice Address - Street 1:6179 S BALSAM WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3091
Practice Address - Country:US
Practice Address - Phone:303-972-2000
Practice Address - Fax:720-245-2690
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO31178208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01311786Medicaid
COF39423Medicare UPIN