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Individual

DR. MAHKAMEH GHADIMI TRACY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
4318 TRAIL BOSS DR STE 100, CASTLE ROCK, CO 80104-7512
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DR.0050393
CO
207QA0000X
Adolescent Medicine (Family Medicine) Physician
DR.0050393
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
029172
KAIASER COMMERCIAL NUMBER
CO
05
58422757
CO
Enumeration date
06/30/2008
Last updated
06/17/2021
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