Individual
MICHAEL DISTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13123 E 16TH AVE, AURORA, CO 80045-7106
(720) 777-1234
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
(303) 493-7000
(720) 777-7317
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
M2307
TX
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
51012
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177033101
—
TX
Enumeration date
10/17/2006
Last updated
07/03/2012
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