Provider Demographics
NPI:1619114337
Name:HONAGANAHALLI, DEEPAK KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:KUMAR
Last Name:HONAGANAHALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4034
Mailing Address - Fax:970-490-4347
Practice Address - Street 1:7000 E BELLEVIEW AVE STE 209
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1622
Practice Address - Country:US
Practice Address - Phone:720-482-3777
Practice Address - Fax:720-482-3776
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0047606207R00000X
MA224530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09787224Medicaid
COCOAAA0012Medicare Oscar/Certification