Healthcare Provider Details

I. General information

NPI: 1770504607
Provider Name (Legal Business Name): LAUREN DEALLEAUME MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 W ALAMEDA AVE STE 20
LAKEWOOD CO
80226-3075
US

IV. Provider business mailing address

8015 W ALAMEDA AVE
LAKEWOOD CO
80226-3041
US

V. Phone/Fax

Practice location:
  • Phone: 720-418-7196
  • Fax:
Mailing address:
  • Phone: 866-808-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD39986
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: