Provider Demographics
NPI:1134322498
Name:KHAKWANI, HARRIS KHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:KHAN
Last Name:KHAKWANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3815 E BELL RD STE 2200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2139
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:3540 E BASELINE RD
Practice Address - Street 2:130
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-9627
Practice Address - Country:US
Practice Address - Phone:623-251-7559
Practice Address - Fax:623-266-4012
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ42338207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ449680Medicaid
AZZ148910Medicare PIN
AZZ131828Medicare PIN