MEDICARE: NILLY MOHAMMED

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	342000000X	Transportation Network Company
2	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1447982038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NILLY MOHAMMED

Provider Business Mailing Address
First Line	:	1642 S PARKER RD STE 207A
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2916
Country	:	US
Telephone Number	:	303-668-7578
Fax Number	:	303-352-9372

Provider Business Practice Location Address
First Line	:	1642 S PARKER RD STE 207A
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2916
Country	:	US
Telephone Number	:	303-668-7578
Fax Number	:	303-352-9372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	06/30/2022

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