Healthcare Provider Details

I. General information

NPI: 1487317632
Provider Name (Legal Business Name): MARWAN AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 05/07/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 16TH ST
PUEBLO CO
81003-2745
US

IV. Provider business mailing address

400 W 16TH ST
PUEBLO CO
81003-2745
US

V. Phone/Fax

Practice location:
  • Phone: 719-584-4921
  • Fax: 719-595-7994
Mailing address:
  • Phone: 773-595-6086
  • Fax: 719-595-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0072815
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: