Provider Demographics
NPI:1699794933
Name:CREST, MICHAEL (CSFA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CREST
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80151-0663
Mailing Address - Country:US
Mailing Address - Phone:303-777-0903
Mailing Address - Fax:303-495-5016
Practice Address - Street 1:581 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4307
Practice Address - Country:US
Practice Address - Phone:303-777-0903
Practice Address - Fax:303-495-5016
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA0001028246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant