Basic Information
| Provider Information | |||||||||
| NPI: | 1649306390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PREECE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 49846 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | L-227552 | MA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 26147 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 04-34934 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD17493 | HI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 54301 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1649306390 | 05 | CA | MEDICAID | 1649306390 | 05 | UT | MEDICAID | 1649306390 | 05 | SD | MEDICAID | 1649306390 | 05 | IA | MEDICAID | 1528962 | 05 | TN | MEDICAID | 1649306390 | 05 | NV | MEDICAID | 1649306390 | 05 | MT | MEDICAID | 200869030A | 05 | KS | MEDICAID | 0302451 | 05 | WA | MEDICAID | 200653220A | 05 | OK | MEDICAID | 860155 | 05 | AZ | MEDICAID | 1649306390 | 05 | IL | MEDICAID | 49001779 | 05 | CO | MEDICAID | 1649306390 | 05 | WY | MEDICAID |