| Doctor Name: | MICHAEL SEAN MCKISIC |
| NPI Number: | 1497950273 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 0116019544 |
| Business Practice Address: | 1725 E Boulder St Suite 101 Colorado Springs, CO - 809095768 |
| Business Phone Number: | 7193656300 |
| Business Fax Number: | |
| Mailing Address: | 2695 Rocky Mountain Ave, Suite 150 LOVELAND |
| State: | CO |
| Postal Code: | 805388702 |
| Phone Number: | 9706244443 |
| Fax Number: | 9704904175 |
| NPI Enumeration Date: | 06/20/2007 |
| NPI Last Update Date: | 01/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 0116019544 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |