Individual
MICHAEL THOMAS FACKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 W 16TH ST, PUEBLO, CO 81003-2745
(719) 584-4921
(719) 595-7994
Mailing address
PO BOX 560825, DENVER, CO 80256-0825
(719) 595-7580
(719) 545-0176
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DR.0062301
CO
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/07/2016
Last updated
06/19/2019
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