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General NPI Number Information
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NPI Number | 1780238436
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Entity Type | Individual
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Provider Name | MICHAEL VAN PELT PA
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Gender | Male
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Dates
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Enumeration Date | 07/31/2019
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 5996 E 64TH AVE
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City | COMMERCE CITY
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State | CO
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Zip | 80022-3317
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Country | US
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Telephone | 720-792-0971
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Fax |
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Provider Business Mailing Address
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Address Line | 5996 E 64TH AVE
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City | COMMERCE CITY
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State | CO
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Zip | 80022-3317
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Country | US
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Telephone | 720-792-0791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 13128
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0007067
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18266
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License Number State | TX
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