Healthcare Provider Details

I. General information

NPI: 1548256936
Provider Name (Legal Business Name): NAMPALLI K VIJAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 5000
DENVER CO
80218-1254
US

IV. Provider business mailing address

4900 S MONACO ST #210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-7100
  • Fax: 303-839-7249
Mailing address:
  • Phone: 303-839-7100
  • Fax: 303-839-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number21147
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: