Organization
MAGNOLIA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRADEEP RAI (DIRECTOR)
(303) 209-5115
Entity
Organization
Contact information
Practice address
1490 N LAFAYETTE ST STE 104, DENVER, CO 80218-2391
(303) 209-5115
Mailing address
PO BOX 29605, DEPT # 800927, PHOENIX, AZ 85038-9605
(303) 209-5115
(720) 638-5562
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
02/22/2024
Last updated
02/17/2026
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