Provider Demographics
NPI:1770674764
Name:KHALSA, ANN M (MD)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:M
Last Name:KHALSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SADHNA
Other - Middle Name:K
Other - Last Name:KHALSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2929 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8034
Mailing Address - Country:US
Mailing Address - Phone:602-470-5000
Mailing Address - Fax:
Practice Address - Street 1:1144 E MCDOWELL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2664
Practice Address - Country:US
Practice Address - Phone:602-344-6550
Practice Address - Fax:602-344-6551
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43010207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ523889Medicaid
AZ523889Medicaid
AZZ137963Medicare PIN