Provider Demographics
NPI:1992325104
Name:TAWFIK, MENA MAHER (MD)
Entity type:Individual
Prefix:
First Name:MENA
Middle Name:MAHER
Last Name:TAWFIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2781
Mailing Address - Country:US
Mailing Address - Phone:719-595-7585
Mailing Address - Fax:719-595-7589
Practice Address - Street 1:1600 N GRAND AVE STE 150
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2755
Practice Address - Country:US
Practice Address - Phone:719-595-7680
Practice Address - Fax:719-595-7589
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0008372207RG0100X, 390200000X
CODR0071714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program