Provider Demographics
NPI:1104010818
Name:KHALSA, GURU NARAYAN (MD)
Entity Type:Individual
Prefix:
First Name:GURU
Middle Name:NARAYAN
Last Name:KHALSA
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:PO BOX 561565
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-1565
Mailing Address - Country:US
Mailing Address - Phone:406-414-1826
Mailing Address - Fax:
Practice Address - Street 1:915 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6902
Practice Address - Country:US
Practice Address - Phone:406-414-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100003207R00000X, 208M00000X
MT127039207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine