Provider Demographics
NPI:1831148352
Name:SCHACKEL, GREGORY MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:SCHACKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 MERCADO ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7306
Mailing Address - Country:US
Mailing Address - Phone:970-385-7272
Mailing Address - Fax:970-385-7299
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:SUITE 205
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-385-7272
Practice Address - Fax:970-385-7299
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO44598207Y00000X
NM90296207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84687215Medicaid
NME35359Medicare UPIN