Provider Demographics
NPI:1386757508
Name:EDDY, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:EDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 E 15TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8938
Mailing Address - Country:US
Mailing Address - Phone:970-669-9100
Mailing Address - Fax:970-669-0400
Practice Address - Street 1:3520 E 15TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8938
Practice Address - Country:US
Practice Address - Phone:970-669-9100
Practice Address - Fax:970-669-0400
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40112208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY136739100Medicaid
CO29939232Medicaid
P00357967Medicare PIN
COH55909Medicare UPIN
WY136739100Medicaid
COCOA107421Medicare PIN