Provider Demographics
NPI:1205982881
Name:ACHUTHAN, HEMAMALINI (MD)
Entity type:Individual
Prefix:DR
First Name:HEMAMALINI
Middle Name:
Last Name:ACHUTHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEMAMALINI
Other - Middle Name:
Other - Last Name:ACHUTHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5183 S JAMAICA WAY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3825
Mailing Address - Country:US
Mailing Address - Phone:720-238-2227
Mailing Address - Fax:
Practice Address - Street 1:8015 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3041
Practice Address - Country:US
Practice Address - Phone:303-202-0924
Practice Address - Fax:303-785-0927
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09609032Medicaid
CO09609032Medicaid