Provider Demographics
NPI:1780627596
Name:HALENKAMP, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HALENKAMP
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 1:2405 RESEARCH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1604
Mailing Address - Country:US
Mailing Address - Phone:719-522-1134
Mailing Address - Fax:719-268-2819
Practice Address - Street 1:PO BOX 544
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-0544
Practice Address - Country:US
Practice Address - Phone:719-522-1134
Practice Address - Fax:719-268-2819
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82100208000000X
CO45699208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83775552Medicaid
CO83775552Medicaid
CO81229Medicare PIN