Provider Demographics
NPI:1255662250
Name:DR. MATTHEW KHUMALO, MD PC
Entity Type:Organization
Organization Name:DR. MATTHEW KHUMALO, MD PC
Other - Org Name:DESERT PALM FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KHUMALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-857-0109
Mailing Address - Street 1:2181 E PECOS RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6140
Mailing Address - Country:US
Mailing Address - Phone:480-857-0109
Mailing Address - Fax:480-398-3643
Practice Address - Street 1:2181 E PECOS RD
Practice Address - Street 2:SUITE #1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6140
Practice Address - Country:US
Practice Address - Phone:480-857-0109
Practice Address - Fax:480-398-3643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37296207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty