MEDICARE: LARA MICHELLE FELIX MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	DR.0077723	CO

General Provider Information

NPI Number	:	1568164200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA MICHELLE FELIX MD

Provider Business Mailing Address
First Line	:	777 BANNOCK ST # MC0108
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4507
Country	:	US
Telephone Number	:	303-602-5193
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 BANNOCK ST # MC0108
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4507
Country	:	US
Telephone Number	:	303-602-5193
Fax Number	:

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

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	06/19/2026

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