Healthcare Provider Details

I. General information

NPI: 1780627596
Provider Name (Legal Business Name): MICHAEL HALENKAMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 544
MONUMENT CO
80132-0544
US

IV. Provider business mailing address

2405 RESEARCH PARKWAY
COLORADO SPRINGS CO
80920-1604
US

V. Phone/Fax

Practice location:
  • Phone: 719-522-1134
  • Fax: 719-268-2819
Mailing address:
  • Phone: 719-522-1134
  • Fax: 719-268-2819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME82100
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45699
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: