Provider Demographics
NPI:1992023394
Name:MORAN, MICHAEL G (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:MORAN
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 1:3400 E BAYAUD AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2926
Mailing Address - Country:US
Mailing Address - Phone:303-861-1575
Mailing Address - Fax:
Practice Address - Street 1:3400 E BAYAUD AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2926
Practice Address - Country:US
Practice Address - Phone:303-861-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO227342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry