Individual
FERNANDO THADEPALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12230 LIONESS WAY, PARKER, CO 80134-5603
(720) 644-9355
Mailing address
12230 LIONESS WAY, PARKER, CO 80134-5603
(720) 644-9355
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
43458
MN
207R00000X
Internal Medicine Physician
Primary
DR.0059540
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000164657
—
CO
Enumeration date
12/30/2005
Last updated
09/30/2021
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