Provider Demographics
NPI:1831185776
Name:PREVEDEL, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:PREVEDEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-750-0822
Mailing Address - Fax:303-750-1298
Practice Address - Street 1:1444 S POTOMAC STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4510
Practice Address - Country:US
Practice Address - Phone:303-750-0822
Practice Address - Fax:303-750-1298
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-04-15
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Provider Licenses
StateLicense IDTaxonomies
CO24985207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01909223Medicaid
CO01249853Medicaid
NE10026280700Medicaid
KS100174090DMedicaid
NE10026280600Medicaid
NE10026280800Medicaid
NE10026283100Medicaid
NE10026281000Medicaid
NE10026281200Medicaid
NE1982948089Medicaid
WY109800400Medicaid
KS100174090DMedicaid
CO01249853Medicaid
NM01909223Medicaid
NE10026281000Medicaid
COA02088Medicare UPIN