Provider Demographics
NPI:1720758774
Name:AMALAHA, GERALD CHUKWUDI
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:CHUKWUDI
Last Name:AMALAHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 BROADWAY STE K
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-2853
Mailing Address - Country:US
Mailing Address - Phone:405-778-0712
Mailing Address - Fax:
Practice Address - Street 1:5650 ARGONNE ST APT 3201
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8830
Practice Address - Country:US
Practice Address - Phone:405-778-0712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO844644336Medicaid