Individual
BENJAMIN MICELI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1107 S LEMAY AVE, SUITE 240, FORT COLLINS, CO 80524-3960
(970) 495-7421
(970) 495-7424
Mailing address
1107 S LEMAY AVE, SUITE 240, FORT COLLINS, CO 80524-3960
(970) 495-7421
(970) 495-7424
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0003875
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14330318
—
CO
Enumeration date
01/22/2014
Last updated
09/18/2024
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