Healthcare Provider Details

I. General information

NPI: 1205812104
Provider Name (Legal Business Name): MICHAEL A MONTICELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 N NEVADA AVE STE 400
COLORADO SPRINGS CO
80907-5320
US

IV. Provider business mailing address

7951 E MAPLEWOOD AVE STE 300
GREENWOOD VILLAGE CO
80111-4726
US

V. Phone/Fax

Practice location:
  • Phone: 719-577-2555
  • Fax: 719-793-7053
Mailing address:
  • Phone: 303-930-7803
  • Fax: 303-930-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0035987
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD21314
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: