Healthcare Provider Details

I. General information

NPI: 1568082352
Provider Name (Legal Business Name): MICHAEL MOUSSELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9005 GRANT ST STE 200
THORNTON CO
80229-4384
US

IV. Provider business mailing address

9005 GRANT ST STE 200
THORNTON CO
80229-4384
US

V. Phone/Fax

Practice location:
  • Phone: 303-287-2800
  • Fax: 303-287-7357
Mailing address:
  • Phone: 303-287-2800
  • Fax: 303-287-7357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20A20856
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberDR.0071585
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: