Healthcare Provider Details

I. General information

NPI: 1639179500
Provider Name (Legal Business Name): MICHAEL PAOLUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 S RIO GRANDE AVE
MONTROSE CO
81401-4847
US

IV. Provider business mailing address

2920 N CASCADE AVE STE 301
COLORADO SPRINGS CO
80907-6265
US

V. Phone/Fax

Practice location:
  • Phone: 970-497-5979
  • Fax: 970-497-5983
Mailing address:
  • Phone: 719-636-1201
  • Fax: 719-636-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberJ2249
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDR.0066635
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: