Provider Demographics
NPI:1518133602
Name:KHOKHAR, SABA PERVEZ (MD)
Entity Type:Individual
Prefix:
First Name:SABA
Middle Name:PERVEZ
Last Name:KHOKHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-7395
Mailing Address - Country:US
Mailing Address - Phone:248-821-5821
Mailing Address - Fax:
Practice Address - Street 1:100 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-7395
Practice Address - Country:US
Practice Address - Phone:248-821-5821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301088576OtherLICENSE
MA110098248AMedicaid
MI20-5485614OtherTAX ID
MI11-0F33636-0OtherBCBSM PIN
MI1346398971OtherGRP NPI