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Individual

MICHELLE RENEE ROOT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
155 PRINTERS PKWY, COLORADO SPRINGS, CO 80910-6100
(719) 632-5700
(719) 344-7817
Mailing address
3205 N ACADEMY BLVD, SUITE 130, COLORADO SPRINGS, CO 80917-5147
(719) 632-5700
(719) 344-7817

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
999
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
999
STATE LICENSE
CO
Enumeration date
08/28/2008
Last updated
04/05/2017
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