Healthcare Provider Details

I. General information

NPI: 1861328627
Provider Name (Legal Business Name): MICHAH PORTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 BRIARGATE PKWY
COLORADO SPRINGS CO
80920-7815
US

IV. Provider business mailing address

4050 BRIARGATE PKWY
COLORADO SPRINGS CO
80920-7815
US

V. Phone/Fax

Practice location:
  • Phone: 719-364-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberQ171719
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: