Basic Information
| Provider Information | |||||||||
| NPI: | 1457381964 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALESSI | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 ROCKY MOUNTAIN AVE | ||||||||
| Address2: | NORTH MEDICAL OFFICE BUILDING | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805389004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702037050 | ||||||||
| FaxNumber: | 9702037055 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 ROCKY MOUNTAIN AVE | ||||||||
| Address2: | NORTH MEDICAL OFFICE BUILDING | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805389004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702037050 | ||||||||
| FaxNumber: | 9702037055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 09/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 35589 | CO | N | Other Service Providers | Specialist | 207R00000X | 35589 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 118112200 | 05 | WY | MEDICAID | P00944656 | 01 | CO | MEDICARE RAILROAD CARRIER PTAN | OTHER | 01355890 | 05 | CO | MEDICAID |