Healthcare Provider Details

I. General information

NPI: 1699794933
Provider Name (Legal Business Name): MICHAEL CREST CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 S WASHINGTON ST
DENVER CO
80209-4307
US

IV. Provider business mailing address

PO BOX 663
ENGLEWOOD CO
80151-0663
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-0903
  • Fax: 303-495-5016
Mailing address:
  • Phone: 303-777-0903
  • Fax: 303-495-5016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA0001028
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: