Individual
MICHAEL JOHN PANTALEO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
EVANS ARMY COMMUNITY HOSPITAL, COCHRAN CIRCLE, FT CARSON, CO 80913
(719) 526-7902
Mailing address
1382 BROOKCRESS DR, GOLDEN, CO 80401-8018
(303) 526-2646
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1717
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1717
PSYCHOLOGIST LIC NUMBER
CO
Enumeration date
01/23/2006
Last updated
07/08/2007
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