Provider Demographics
NPI:1770733743
Name:NALLEGOWDA, MALLIKARJUNA (MD, DNB, MNAMS)
Entity type:Individual
Prefix:DR
First Name:MALLIKARJUNA
Middle Name:
Last Name:NALLEGOWDA
Suffix:
Gender:M
Credentials:MD, DNB, MNAMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9000
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-9000
Mailing Address - Country:US
Mailing Address - Phone:719-557-3666
Mailing Address - Fax:719-557-3633
Practice Address - Street 1:3676 PARKER BLVD STE 230
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2213
Practice Address - Country:US
Practice Address - Phone:719-553-2200
Practice Address - Fax:833-916-2049
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO52039208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine