Healthcare Provider Details

I. General information

NPI: 1316948797
Provider Name (Legal Business Name): BARRY MIGICOVSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 BROADWAY ST
BOULDER CO
80304-3586
US

IV. Provider business mailing address

2750 BROADWAY ST
BOULDER CO
80304-3586
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-3216
  • Fax: 303-440-3209
Mailing address:
  • Phone: 303-440-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0073276
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: