Healthcare Provider Details

I. General information

NPI: 1386566305
Provider Name (Legal Business Name): MOHAMED S MAHGOUB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 E ILIFF AVE APT 2118
DENVER CO
80231-4270
US

IV. Provider business mailing address

1582 S PARKER RD # B-202
DENVER CO
80231-2714
US

V. Phone/Fax

Practice location:
  • Phone: 720-261-2500
  • Fax:
Mailing address:
  • Phone: 720-261-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: