Healthcare Provider Details

I. General information

NPI: 1699850677
Provider Name (Legal Business Name): LEWIS ALBERT FRATERELLI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5039 S FEDERAL BLVD SUITE 5
ENGLEWOOD CO
80110-6369
US

IV. Provider business mailing address

5039 S FEDERAL BLVD SUITE 5
ENGLEWOOD CO
80110-6369
US

V. Phone/Fax

Practice location:
  • Phone: 303-798-2559
  • Fax: 303-798-9321
Mailing address:
  • Phone: 303-798-2559
  • Fax: 303-798-9321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number15323
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: