1760480453 NPI number — DR. MASROOR U KAKAKHEL MD

Table of content: DR. MASROOR U KAKAKHEL MD (NPI 1760480453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760480453 NPI number — DR. MASROOR U KAKAKHEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAKAKHEL
Provider First Name:
MASROOR
Provider Middle Name:
U
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760480453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2930 11TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80620-1011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-353-9403
Provider Business Mailing Address Fax Number:
970-353-9906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N 11TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREELEY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80631-2011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-352-8898
Provider Business Practice Location Address Fax Number:
970-351-7075
Provider Enumeration Date:
07/07/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  37532 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11133741 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".