MEDICARE: MR. MICHEAL DEITZ PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	560	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00944690	OTHER	CO	MEDICARE RAILROAD CARRIER PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033180518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHEAL DEITZ PA-C

Provider Business Mailing Address
First Line	:	2315 E HARMONY RD STE 170
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8620
Country	:	US
Telephone Number	:	970-495-8450
Fax Number	:	970-297-6599

Provider Business Practice Location Address
First Line	:	2315 E HARMONY RD STE 170
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8620
Country	:	US
Telephone Number	:	970-495-8450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	12/28/2020

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Directions to “ MR. MICHEAL DEITZ PA-C” Practice Location

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