MEDICARE: DR. JOHN MICHAEL PADDACK M.D.

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	208800000X	Urology Physician	53595	CO

General Provider Information

NPI Number	:	1780819607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL PADDACK M.D.

Provider Business Mailing Address
First Line	:	10200 GRAND CENTRAL AVE STE 220
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4366
Country	:	US
Telephone Number	:	410-581-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 MOUNTAIN VIEW AVE STE 420
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3182
Country	:	US
Telephone Number	:	303-776-9400
Fax Number	:

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	06/03/2025

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