Healthcare Provider Details

I. General information

NPI: 1497728372
Provider Name (Legal Business Name): MICHAEL G. CRINCOLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 3650
DENVER CO
80218-1282
US

IV. Provider business mailing address

6807 N 14TH ST
PHOENIX AZ
85014-1133
US

V. Phone/Fax

Practice location:
  • Phone: 720-583-5379
  • Fax: 888-384-2827
Mailing address:
  • Phone: 617-538-3650
  • Fax: 888-384-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number82036
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number44220
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberCDR.0000553
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: