Healthcare Provider Details

I. General information

NPI: 1164425047
Provider Name (Legal Business Name): MICHAEL AUSTIN GLASS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11960 LIONESS WAY SUITE 210
PARKER CO
80134-0000
US

IV. Provider business mailing address

11960 LIONESS WAY SUITE 210
PARKER CO
80134-0000
US

V. Phone/Fax

Practice location:
  • Phone: 303-695-8706
  • Fax: 303-695-1211
Mailing address:
  • Phone: 303-695-8706
  • Fax: 303-695-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number34493
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberDR.0034493
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: