Provider Demographics
NPI:1316099286
Name:STEVENSON, MICHAEL JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 N FRANKLIN ST STE 340
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1128
Mailing Address - Country:US
Mailing Address - Phone:303-318-3330
Mailing Address - Fax:303-812-4221
Practice Address - Street 1:1830 N FRANKLIN ST STE 340
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1128
Practice Address - Country:US
Practice Address - Phone:303-318-3330
Practice Address - Fax:303-812-4221
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003530A363A00000X
CO2455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03038050Medicaid
KS200972770AMedicaid
NE1245556091Medicaid
WY129802000Medicaid
CO265729YMCJMedicare PIN
WY129802000Medicaid
NE1245556091Medicaid