MEDICARE: MADISON MICHELLE PARKER 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

General Provider Information

NPI Number	:	1295569663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON MICHELLE PARKER PA-C

Provider Business Mailing Address
First Line	:	12201 PECOS ST STE 500
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-3995
Country	:	US
Telephone Number	:	303-900-0449
Fax Number	:

Provider Business Practice Location Address
First Line	:	12201 PECOS ST STE 500
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-3995
Country	:	US
Telephone Number	:	303-900-0449
Fax Number	:

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

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	12/13/2024

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