MEDICARE: DR. MICHELLE ANN EADS M.D.

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	207Q00000X	Family Medicine Physician	36828	CO
2	207Q00000X	Family Medicine Physician	K0458	TX

General Provider Information

NPI Number	:	1801881305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE ANN EADS M.D.

Provider Business Mailing Address
First Line	:	1040 S 8TH ST
Second Line	:	SUITE 102
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7364
Country	:	US
Telephone Number	:	719-687-8752
Fax Number	:	719-687-8753

Provider Business Practice Location Address
First Line	:	1040 S 8TH ST
Second Line	:	SUITE 102
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7364
Country	:	US
Telephone Number	:	719-687-8752
Fax Number	:	719-687-8753

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	02/05/2015

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