MEDICARE: 3G MEDICAL CONSULTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	DR0052572	CO

General Provider Information

NPI Number	:	1174947741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3G MEDICAL CONSULTANT

Provider Business Mailing Address
First Line	:	421 SECURITY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-1728
Country	:	US
Telephone Number	:	719-368-6628
Fax Number	:	719-368-6629

Provider Business Practice Location Address
First Line	:	421 SECURITY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-1728
Country	:	US
Telephone Number	:	719-368-6628
Fax Number	:	719-368-6629

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RODNEY R MUHAMMAD
Credential	:	D.O.
Telephone Number	:	301-258-1904

Provider Enumeration Date	:	02/18/2014
Last Update Date	:	02/18/2014

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