Provider Demographics
NPI:1386232700
Name:KHUDER, ASLAM
Entity Type:Individual
Prefix:
First Name:ASLAM
Middle Name:
Last Name:KHUDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 16TH AVE S APT 301
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4580
Mailing Address - Country:US
Mailing Address - Phone:773-332-9984
Mailing Address - Fax:
Practice Address - Street 1:3310 16TH AVE S APT 301
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4580
Practice Address - Country:US
Practice Address - Phone:773-332-9984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant