Provider Demographics
NPI:1831327865
Name:GALLIZZI, MICHAEL ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:GALLIZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10107 RIDGEGATE PKWY STE 370
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6003
Mailing Address - Country:US
Mailing Address - Phone:303-790-7181
Mailing Address - Fax:303-768-8028
Practice Address - Street 1:10107 RIDGEGATE PKWY STE 370
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6003
Practice Address - Country:US
Practice Address - Phone:303-790-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009016703207X00000X
NC2014-00466207X00000X
CO55166207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55166OtherCO STATE LICENSE
NC2014-00466OtherNORTH CAROLINA STATE LICENSE
NCNCI785AOtherMEDICARE PTAN