Provider Demographics
NPI:1083819924
Name:HUMA KHUSRO MD PC
Entity Type:Organization
Organization Name:HUMA KHUSRO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHUSRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-547-7778
Mailing Address - Street 1:106 BAY ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5229
Mailing Address - Country:US
Mailing Address - Phone:256-547-7778
Mailing Address - Fax:256-547-7709
Practice Address - Street 1:106 BAY ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5229
Practice Address - Country:US
Practice Address - Phone:256-547-7778
Practice Address - Fax:256-547-7709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19471261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529909210Medicaid
AL529909210Medicaid