# MAGNOLIA MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003672619
- **Authorized official:** PRADEEP RAI (DIRECTOR)
- **Authorized official phone:** (303) 209-5115

## Contact information

- **Practice address:** 1490 N LAFAYETTE ST STE 104, DENVER, CO 80218-2391
- **Practice address phone:** (303) 209-5115
- **Mailing address:** PO BOX 29605, DEPT \# 800927, PHOENIX, AZ 85038-9605
- **Mailing address phone:** (303) 209-5115
- **Mailing address fax:** (720) 638-5562

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/22/2024
- **Last updated:** 02/17/2026