Provider Demographics
NPI:1346889862
Name:IBRAHIM, SHUKRI DAUD
Entity Type:Individual
Prefix:
First Name:SHUKRI
Middle Name:DAUD
Last Name:IBRAHIM
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:PO BOX 1102
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-1102
Mailing Address - Country:US
Mailing Address - Phone:720-400-4736
Mailing Address - Fax:
Practice Address - Street 1:408 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3330
Practice Address - Country:US
Practice Address - Phone:720-400-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-01
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No347C00000XTransportation ServicesPrivate Vehicle
No171R00000XOther Service ProvidersInterpreter
No374U00000XNursing Service Related ProvidersHome Health Aide