Healthcare Provider Details

I. General information

NPI: 1639695083
Provider Name (Legal Business Name): MICHAEL R GIACOPELLI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8225 W 20TH ST
GREELEY CO
80634-3037
US

IV. Provider business mailing address

3702 S TIMBERLINE RD STE A
FORT COLLINS CO
80525-3625
US

V. Phone/Fax

Practice location:
  • Phone: 970-378-1414
  • Fax: 970-348-1515
Mailing address:
  • Phone: 970-207-9773
  • Fax: 970-484-8667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0005938
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: