MEDICARE: DR. CECILE AUDREY MAUGE 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
1	2084P0800X	Psychiatry Physician	49339	CO

General Provider Information

NPI Number	:	1699067603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CECILE AUDREY MAUGE MD

Provider Business Mailing Address
First Line	:	2611 IVY ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3414
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2611 IVY ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3414
Country	:	US
Telephone Number	:	720-879-8534
Fax Number	:	303-703-3535

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

Provider Enumeration Date	:	05/09/2011
Last Update Date	:	05/09/2011

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