MEDICARE: DR. MICHAEL GRAY SHELL D.O.

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	35565	CO

General Provider Information

NPI Number	:	1518925718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL GRAY SHELL D.O.

Provider Business Mailing Address
First Line	:	1551 PROFESSIONAL LN UNIT 180
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-6970
Country	:	US
Telephone Number	:	720-307-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 PROFESSIONAL LN UNIT 180
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-6970
Country	:	US
Telephone Number	:	720-476-3421
Fax Number	:	720-502-5271

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/16/2021

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