Healthcare Provider Details

I. General information

NPI: 1750134482
Provider Name (Legal Business Name): TETE DZRAMEDO TEAGBO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8181 E TUFTS AVE STE 560
DENVER CO
80237-2559
US

IV. Provider business mailing address

25084 E BYERS DR
AURORA CO
80018-4659
US

V. Phone/Fax

Practice location:
  • Phone: 720-669-3480
  • Fax: 720-669-3480
Mailing address:
  • Phone: 720-427-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0999665
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: