Provider Demographics
NPI:1386818342
Name:KASSAB, DURIED MAWAHEB (DO)
Entity type:Individual
Prefix:DR
First Name:DURIED
Middle Name:MAWAHEB
Last Name:KASSAB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12250 E ILIFF AVE
Mailing Address - Street 2:#300
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-6318
Mailing Address - Country:US
Mailing Address - Phone:720-524-1550
Mailing Address - Fax:720-524-1551
Practice Address - Street 1:12250 E ILIFF AVE
Practice Address - Street 2:#300
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6318
Practice Address - Country:US
Practice Address - Phone:720-524-1550
Practice Address - Fax:720-524-1551
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2023-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO49036208M00000X
CODR.0049036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14824779Medicaid
CO14824779Medicaid