Provider Demographics
NPI:1124175831
Name:HEMINGWAY, MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:HEMINGWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MAFFEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 MORNING GLORY AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-8189
Mailing Address - Country:US
Mailing Address - Phone:413-212-1869
Mailing Address - Fax:970-422-8019
Practice Address - Street 1:3710 MAIN AVE # 301
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4033
Practice Address - Country:US
Practice Address - Phone:970-844-5096
Practice Address - Fax:970-422-8019
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49033208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO241560Medicaid