Provider Demographics
NPI:1811135007
Name:CAMP, MICHAEL BRENAN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRENAN
Last Name:CAMP
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 1:1 BROADWAY
Mailing Address - Street 2:BUILDING A, SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3959
Mailing Address - Country:US
Mailing Address - Phone:303-455-6345
Mailing Address - Fax:303-455-6343
Practice Address - Street 1:1 BROADWAY
Practice Address - Street 2:BUILDING A, SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3959
Practice Address - Country:US
Practice Address - Phone:303-455-6345
Practice Address - Fax:303-455-6343
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2662363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant