MEDICARE: DR. LEWIS ALBERT FRATERELLI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	15323	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	D22839	OTHER	CO	UPIN

General Provider Information

NPI Number	:	1699850677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEWIS ALBERT FRATERELLI D.O.

Provider Business Mailing Address
First Line	:	5039 S FEDERAL BLVD
Second Line	:	SUITE 5
City	:	ENGLEWOOD
State	:	CO
Zip	:	80110-6369
Country	:	US
Telephone Number	:	303-798-2559
Fax Number	:	303-798-9321

Provider Business Practice Location Address
First Line	:	5039 S FEDERAL BLVD
Second Line	:	SUITE 5
City	:	ENGLEWOOD
State	:	CO
Zip	:	80110-6369
Country	:	US
Telephone Number	:	303-798-2559
Fax Number	:	303-798-9321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/09/2007

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