Healthcare Provider Details

I. General information

NPI: 1215498530
Provider Name (Legal Business Name): MICHELLE LOIS MOSES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE LOIS MOSES CROSS DO

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 FOXTRAIL DR # 213
LOVELAND CO
80538-9086
US

IV. Provider business mailing address

1635 FOXTRAIL DR # 213
LOVELAND CO
80538-9086
US

V. Phone/Fax

Practice location:
  • Phone: 970-541-1375
  • Fax: 970-233-4563
Mailing address:
  • Phone: 970-541-1375
  • Fax: 970-233-4563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0074659
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDR.0074659
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: