MEDICARE: MOHAMED IBRAHIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347E00000X	Transportation Broker	11-314-0189	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033816236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED IBRAHIM

Provider Business Mailing Address
First Line	:	2195 S JOLIET ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-1034
Country	:	US
Telephone Number	:	720-936-5606
Fax Number	:

Provider Business Practice Location Address
First Line	:	2195 S JOLIET ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-1034
Country	:	US
Telephone Number	:	720-936-5606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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Directions to “ MOHAMED IBRAHIM ” Practice Location

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