Provider Demographics
NPI:1699850677
Name:FRATERELLI, LEWIS ALBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:ALBERT
Last Name:FRATERELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5039 S FEDERAL BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-6369
Mailing Address - Country:US
Mailing Address - Phone:303-798-2559
Mailing Address - Fax:303-798-9321
Practice Address - Street 1:5039 S FEDERAL BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-6369
Practice Address - Country:US
Practice Address - Phone:303-798-2559
Practice Address - Fax:303-798-9321
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15323204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01153238Medicaid
COD22839OtherUPIN
CA0392-2Medicare ID - Type UnspecifiedMEDICARE