Individual
MR. MICHEAL DEITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2315 E HARMONY RD STE 170, FORT COLLINS, CO 80528-8620
(970) 495-8450
Mailing address
2315 E HARMONY RD STE 170, FORT COLLINS, CO 80528-8620
(970) 495-8450
(970) 297-6599
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
560
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07005606
—
CO
01
—
P00944690
MEDICARE RAILROAD CARRIER PTAN
CO
Enumeration date
01/31/2006
Last updated
12/28/2020
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