Provider Demographics
NPI:1003900614
Name:KHATCHIKIAN, GARABET S (MD)
Entity Type:Individual
Prefix:
First Name:GARABET
Middle Name:S
Last Name:KHATCHIKIAN
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 1:508 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2343
Mailing Address - Country:US
Mailing Address - Phone:507-372-2921
Mailing Address - Fax:507-372-1815
Practice Address - Street 1:508 10TH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2343
Practice Address - Country:US
Practice Address - Phone:507-372-2921
Practice Address - Fax:507-372-1815
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN125885OtherUCARE
MN01G28KHOtherBCBS MPIN
IA0512087Medicaid
MN176021100Medicaid
MN110164895OtherRR MEDICARE