Provider Demographics
NPI:1902069545
Name:STREETER, MICHELE ANGELEC (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ANGELEC
Last Name:STREETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:ANGELEC
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-0429
Mailing Address - Country:US
Mailing Address - Phone:719-530-2000
Mailing Address - Fax:719-539-5068
Practice Address - Street 1:1000 RUSH DR FL 3
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9627
Practice Address - Country:US
Practice Address - Phone:719-530-2309
Practice Address - Fax:719-539-5068
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO52421207YX0007X
VA0101247613207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery