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NPI Code Detail

MEDICARE: MICHAEL MARTIN II

MEDICARE: MICHAEL MARTIN II
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
1106S00000XBehavior Technician20-112720CO

General Provider Information

NPI Number : 1184064032
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL MARTIN II
Provider Business Mailing Address
First Line : 7483 SANDY SPRINGS PT
Second Line :
City : FOUNTAIN
State : CO
Zip : 80817-4074
Country : US
Telephone Number : 620-253-0790
Fax Number :
Provider Business Practice Location Address
First Line : 1915 AEROTECH DR STE 190
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80916-4213
Country : US
Telephone Number : 719-301-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2013
Last Update Date : 02/25/2020

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Directions to “ MICHAEL MARTIN II ” Practice Location

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