Provider Demographics
NPI:1306901236
Name:HEMAMALINI ACHUTHAN .M.D., P.C
Entity type:Organization
Organization Name:HEMAMALINI ACHUTHAN .M.D., P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEMAMALINI
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHUTHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-202-0924
Mailing Address - Street 1:PO BOX 281169
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-8169
Mailing Address - Country:US
Mailing Address - Phone:303-202-0924
Mailing Address - Fax:303-785-0927
Practice Address - Street 1:8015 W ALAMEDA AVE
Practice Address - Street 2:#150
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226
Practice Address - Country:US
Practice Address - Phone:303-202-0924
Practice Address - Fax:303-989-8939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020640Medicaid
CO04020640Medicaid
COCM8408Medicare PIN