Healthcare Provider Details

I. General information

NPI: 1871240101
Provider Name (Legal Business Name): MOHAMMED HASAN NEMAT AL-MUSAWI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 COURT ST
PUEBLO CO
81003-2715
US

IV. Provider business mailing address

1401 COURT ST
PUEBLO CO
81003-2715
US

V. Phone/Fax

Practice location:
  • Phone: 719-562-2300
  • Fax: 719-562-2095
Mailing address:
  • Phone: 719-562-2300
  • Fax: 719-562-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberDR.0075280
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: