Provider Demographics
NPI:1134955305
Name:MOHAMMED, EHAB ABDLATEF AHMED
Entity type:Individual
Prefix:
First Name:EHAB
Middle Name:ABDLATEF AHMED
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S PARKER RD STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-7564
Mailing Address - Country:US
Mailing Address - Phone:720-451-9748
Mailing Address - Fax:
Practice Address - Street 1:1200 S PARKER RD STE 210
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-7564
Practice Address - Country:US
Practice Address - Phone:720-451-9748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04D01U376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker