Provider Demographics
NPI:1669493805
Name:GHUNEIM, GHASSAN MOHAMED
Entity Type:Individual
Prefix:
First Name:GHASSAN
Middle Name:MOHAMED
Last Name:GHUNEIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GHASSAN
Other - Middle Name:M
Other - Last Name:GHUNEIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5920 MCINTYRE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7445
Mailing Address - Country:US
Mailing Address - Phone:720-434-4876
Mailing Address - Fax:303-225-4246
Practice Address - Street 1:5920 MCINTYRE ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-7445
Practice Address - Country:US
Practice Address - Phone:720-434-4876
Practice Address - Fax:303-225-4246
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0051042207Q00000X, 208M00000X
NM2000-193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01330332OtherRAIL ROAD MEDICARE
CO49056379Medicaid
CO320418YL2GMedicare PIN