Healthcare Provider Details

I. General information

NPI: 1154232395
Provider Name (Legal Business Name): NURUL ALAM PROVIDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6172 S FUNDY WAY
AURORA CO
80016-3860
US

IV. Provider business mailing address

6172 S FUNDY WAY
AURORA CO
80016-3860
US

V. Phone/Fax

Practice location:
  • Phone: 303-921-0587
  • Fax: --
Mailing address:
  • Phone: 303-921-0587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number20258372225
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number2024
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: