Provider Demographics
NPI:1801881305
Name:EADS, MICHELLE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANN
Last Name:EADS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1040 S 8TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7364
Mailing Address - Country:US
Mailing Address - Phone:719-687-8752
Mailing Address - Fax:719-687-8753
Practice Address - Street 1:1040 S 8TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-7364
Practice Address - Country:US
Practice Address - Phone:719-687-8752
Practice Address - Fax:719-687-8753
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2015-02-05
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Provider Licenses
StateLicense IDTaxonomies
CO36828207Q00000X
TXK0458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG37926Medicare UPIN