Provider Demographics
NPI:1316192024
Name:MOHAMMAD M KHAN M.D.
Entity Type:Organization
Organization Name:MOHAMMAD M KHAN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-344-9000
Mailing Address - Street 1:1025 W 24TH ST
Mailing Address - Street 2:SUITE #27
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8366
Mailing Address - Country:US
Mailing Address - Phone:928-344-9000
Mailing Address - Fax:928-344-9002
Practice Address - Street 1:1025 W 24TH ST
Practice Address - Street 2:SUITE #27
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8366
Practice Address - Country:US
Practice Address - Phone:928-344-9000
Practice Address - Fax:928-344-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13786207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD44114Medicare UPIN