MEDICARE: J MICHAEL KING MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1104113430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J MICHAEL KING MD PC

Provider Business Mailing Address
First Line	:	1276 HAWK RIDGE RD
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-2985
Country	:	US
Telephone Number	:	720-401-2139
Fax Number	:	303-469-2898

Provider Business Practice Location Address
First Line	:	403 SUMMIT BLVD UNIT 204
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-8253
Country	:	US
Telephone Number	:	720-401-2139
Fax Number	:	303-469-2898

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUSTIN MICHAEL KING
Credential	:	M.D.
Telephone Number	:	720-401-2139

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	04/25/2018

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