Provider Demographics
NPI:1558322875
Name:KHAN, MUSTARI (MD)
Entity Type:Individual
Prefix:
First Name:MUSTARI
Middle Name:
Last Name:KHAN
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 1:9201 W THOMAS ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037
Mailing Address - Country:US
Mailing Address - Phone:623-327-7313
Mailing Address - Fax:623-327-5437
Practice Address - Street 1:9201 W THOMAS RD
Practice Address - Street 2:BANNER ESTRELLA MEDICAL CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3332
Practice Address - Country:US
Practice Address - Phone:623-327-7313
Practice Address - Fax:623-327-5437
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32986208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ905523Medicaid
AZP00276772OtherRR MEDICARE
AZP00276772OtherRR MEDICARE
AZI21429Medicare UPIN