Provider Demographics
NPI:1619682374
Name:KHAKWANI AND MOHAMMAD MEDICAL PC
Entity Type:Organization
Organization Name:KHAKWANI AND MOHAMMAD MEDICAL PC
Other - Org Name:PEORIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-221-5944
Mailing Address - Street 1:2460 PASEO VERDE PKWY STE 145
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7142
Mailing Address - Country:US
Mailing Address - Phone:702-820-5713
Mailing Address - Fax:
Practice Address - Street 1:20542 N LAKE PLEASANT RD STE 115
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9749
Practice Address - Country:US
Practice Address - Phone:623-476-5820
Practice Address - Fax:623-476-5815
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KHAKWANI AND MOHAMMAD MEDICAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-17
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty