Healthcare Provider Details

I. General information

NPI: 1740411743
Provider Name (Legal Business Name): WILLIAM MICHAEL PICKETT CST/CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 COLORADO BLVD APT# 5118
DENVER CO
80206-4086
US

IV. Provider business mailing address

901 COLORADO BLVD APT# 5118
DENVER CO
80206-4086
US

V. Phone/Fax

Practice location:
  • Phone: 303-229-5810
  • Fax:
Mailing address:
  • Phone: 303-229-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number115792
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: