Provider Demographics
NPI:1043254220
Name:PAYNE, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3895
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE249892085R0202X
KS04-365262085R0202X
HIMD175262085R0202X
CO413492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025709000Medicaid
MO200125805Medicaid
AZ927254Medicaid
CA1043254220Medicaid
CO48374369Medicaid
ID807445800Medicaid
OK200258680AMedicaid
WA1043254220Medicaid
KS200335510AMedicaid
TX317571301Medicaid
NE84-059792913Medicaid
SD1043254220/7726540Medicaid
NM22123270Medicaid
WY1043254220Medicaid
IA1043254220Medicaid
MI104686300Medicaid
NC7617658Medicaid
WI99112260Medicaid
NC7617658Medicaid
WY1043254220Medicaid
IA1043254220Medicaid
WA1043254220Medicaid
NM22123270Medicaid
MO200125805Medicaid
CA1043254220Medicaid
KS111257009Medicare PIN
KSKA3249037Medicare PIN
COP00002658Medicare PIN
COC482448Medicare PIN
COC492438Medicare PIN
NENA1215022Medicare PIN
CO48374369Medicaid
NE84-059792913Medicaid
NENA1214022Medicare PIN
COH61648Medicare UPIN
NC7617658Medicaid