Provider Demographics
NPI:1659462455
Name:KHOSLA, SEEMA (MD)
Entity Type:Individual
Prefix:
First Name:SEEMA
Middle Name:
Last Name:KHOSLA
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 1:4152 30TH AVE S
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8403
Mailing Address - Country:US
Mailing Address - Phone:701-356-3000
Mailing Address - Fax:701-271-9260
Practice Address - Street 1:4152 30TH AVE S
Practice Address - Street 2:SUITE 103B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8403
Practice Address - Country:US
Practice Address - Phone:701-356-3000
Practice Address - Fax:701-271-9260
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10030207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13547Medicaid
NDN715271Medicare PIN
ND13547Medicaid