MEDICARE: DR. MICHAEL KERRIGAN PH.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	103G00000X	Clinical Neuropsychologist	1426	CO

General Provider Information

NPI Number	:	1881613156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL KERRIGAN PH.D.

Provider Business Mailing Address
First Line	:	3649 S NEWLAND ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80235-2622
Country	:	US
Telephone Number	:	303-988-8819
Fax Number	:

Provider Business Practice Location Address
First Line	:	3649 S NEWLAND ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80235-2622
Country	:	US
Telephone Number	:	303-528-6831
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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