MEDICARE: WILLIAM MICHAEL PICKETT CST/CFA

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	246ZC0007X	Surgical Assistant	115792	CO

General Provider Information

NPI Number	:	1740411743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM MICHAEL PICKETT CST/CFA

Provider Business Mailing Address
First Line	:	901 COLORADO BLVD
Second Line	:	APT# 5118
City	:	DENVER
State	:	CO
Zip	:	80206-4086
Country	:	US
Telephone Number	:	303-229-5810
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 COLORADO BLVD
Second Line	:	APT# 5118
City	:	DENVER
State	:	CO
Zip	:	80206-4086
Country	:	US
Telephone Number	:	303-229-5810
Fax Number	:

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

Provider Enumeration Date	:	08/07/2009
Last Update Date	:	08/07/2009

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