MEDICARE: MICHELE LEE PANE PA-C

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	363A00000X	Physician Assistant	2896	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225368418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE LEE PANE PA-C

Provider Business Mailing Address
First Line	:	5400 S PARK TERRACE AVE APT 16-104
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-3368
Country	:	US
Telephone Number	:	303-525-2833
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 S PARK TERRACE AVE APT 16-104
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-3368
Country	:	US
Telephone Number	:	303-525-2833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	01/11/2010

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