Provider Demographics
NPI:1104113430
Name:J MICHAEL KING MD PC
Entity type:Organization
Organization Name:J MICHAEL KING MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-401-2139
Mailing Address - Street 1:1276 HAWK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2985
Mailing Address - Country:US
Mailing Address - Phone:720-401-2139
Mailing Address - Fax:303-469-2898
Practice Address - Street 1:403 SUMMIT BLVD UNIT 204
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8253
Practice Address - Country:US
Practice Address - Phone:720-401-2139
Practice Address - Fax:303-469-2898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty