Healthcare Provider Details

I. General information

NPI: 1386818342
Provider Name (Legal Business Name): DURIED MAWAHEB KASSAB D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 E ILIFF AVE #300
AURORA CO
80014-6318
US

IV. Provider business mailing address

12250 E ILIFF AVE #300
AURORA CO
80014-6318
US

V. Phone/Fax

Practice location:
  • Phone: 720-524-1550
  • Fax: 720-524-1551
Mailing address:
  • Phone: 720-524-1550
  • Fax: 720-524-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number49036
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0049036
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: