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NPI Code Detail

MEDICARE: MORTEZA KHODAEE MD

MEDICARE: MORTEZA KHODAEE MD
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
1207QS0010XSports Medicine (Family Medicine) PhysicianDR.0044723CO
2207Q00000XFamily Medicine PhysicianDR.0044723CO

Other Identifiers

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

General Provider Information

NPI Number : 1538192299
Entity Type Code : Individual
Provider Name (Legal Business Name) : MORTEZA KHODAEE MD
Provider Business Mailing Address
First Line : PO BOX 110429
Second Line :
City : AURORA
State : CO
Zip : 80042-0429
Country : US
Telephone Number : 303-493-7000
Fax Number :
Provider Business Practice Location Address
First Line : 3055 ROSLYN ST
Second Line :
City : DENVER
State : CO
Zip : 80238-3323
Country : US
Telephone Number : 720-848-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2006
Last Update Date : 12/19/2024

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