Provider Demographics
NPI:1912645474
Name:MAIALLEY, MICHAEL (MP/RD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAIALLEY
Suffix:
Gender:M
Credentials:MP/RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11990 GRANT ST STE 550
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1101
Mailing Address - Country:US
Mailing Address - Phone:720-799-5799
Mailing Address - Fax:720-293-9945
Practice Address - Street 1:11990 GRANT ST STE 550
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-1101
Practice Address - Country:US
Practice Address - Phone:720-799-5799
Practice Address - Fax:720-293-9945
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TE1100X, 133N00000X, 133VN1501X, 133NN1002X, 133V00000X, 224Y00000X, 133VN1006X
CO623654712083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty