Provider Demographics
NPI:1730387994
Name:JANE MICELI, MD PROF. LLC
Entity type:Organization
Organization Name:JANE MICELI, MD PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SOLE PROPRIETER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MICELI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-691-6842
Mailing Address - Street 1:3540 S POPLAR ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1360
Mailing Address - Country:US
Mailing Address - Phone:303-691-6842
Mailing Address - Fax:303-322-4540
Practice Address - Street 1:3540 S POPLAR ST
Practice Address - Street 2:SUITE 305
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1360
Practice Address - Country:US
Practice Address - Phone:303-691-6842
Practice Address - Fax:303-322-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO305402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104907708OtherINDIVIDUAL NPI
451368OtherMEDICARE GROUP IDENTIFIER
451378Medicare PIN
F65312Medicare UPIN