Provider Demographics
NPI:1770504607
Name:DEALLEAUME, LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DEALLEAUME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8015 W ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3041
Mailing Address - Country:US
Mailing Address - Phone:866-808-6005
Mailing Address - Fax:
Practice Address - Street 1:8015 W ALAMEDA AVE STE 20
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3075
Practice Address - Country:US
Practice Address - Phone:720-418-7196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMD39986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO080189511OtherRAILROAD MEDICARE
CO06723519Medicaid
CO84-1343242-7SOtherPACIFICARE
CO468198Medicare ID - Type Unspecified
E17645Medicare UPIN