Provider Demographics
NPI:1861223349
Name:MICHELOTTI, MARIA (MPAS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MICHELOTTI
Suffix:
Gender:F
Credentials:MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 S IRONTON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5053
Mailing Address - Country:US
Mailing Address - Phone:406-565-3182
Mailing Address - Fax:
Practice Address - Street 1:676 FUTENMA, GINOWAN
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:90122-2202
Practice Address - Country:US
Practice Address - Phone:819-897-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14186375-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant