Healthcare Provider Details

I. General information

NPI: 1053992628
Provider Name (Legal Business Name): LIELT TEWOLDE BEDILU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12631 E 17TH AVE # MSB216
AURORA CO
80045-2527
US

IV. Provider business mailing address

12631 E 17TH AVE # MSB216
AURORA CO
80045-2527
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-3483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: