Active NPI
Mlou F Wallis, M.D.
- Diagnostic Radiology Physician
- Denver, CO
National Provider Identifier
1811030372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 23213
- Practice address
- 2045 Franklin St
Radiology Department
Denver, CO 80205-5437 - Phone
- (303) 338-4545
- NPI assigned
- Feb 15, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 23213 | CO | Primary |
Addresses
Primary practice location
2045 Franklin St
Radiology Department
Denver, CO 80205-5437
Mailing address
2045 Franklin St
Radiology Department
Denver, CO 80205-5437
Phone (303) 338-4545
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01232131 | Medicaid | CO | |
| 002930 | Other | KAISER-COMMERCIAL NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23213 | CO | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Flatirons Radiology, LLC | Diagnostic Radiology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348617600000",
"number": "1811030372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2045 FRANKLIN ST",
"address_2": "RADIOLOGY DEPARTMENT",
"city": "DENVER",
"state": "CO",
"postal_code": "802055437",
"telephone_number": "303-338-4545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2045 FRANKLIN ST",
"address_2": "RADIOLOGY DEPARTMENT",
"city": "DENVER",
"state": "CO",
"postal_code": "802055437",
"telephone_number": "303-338-4545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLIS",
"first_name": "MLOU",
"middle_name": "F",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-15",
"last_updated": "2012-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "CO",
"license": "23213",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01232131",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER-COMMERCIAL NUMBER",
"identifier": "002930",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.