Provider Demographics
NPI:1326746769
Name:MOHAMED, KHADAR
Entity Type:Individual
Prefix:
First Name:KHADAR
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E KIOWA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-6216
Mailing Address - Country:US
Mailing Address - Phone:720-999-2993
Mailing Address - Fax:
Practice Address - Street 1:216 E KIOWA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-6216
Practice Address - Country:US
Practice Address - Phone:720-999-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care