Provider Demographics
NPI:1801856554
Name:KHURRAM, REEMA (MD)
Entity Type:Individual
Prefix:
First Name:REEMA
Middle Name:
Last Name:KHURRAM
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 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-969-7770
Mailing Address - Fax:
Practice Address - Street 1:1555 S PALM CANYON
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-8374
Practice Address - Country:US
Practice Address - Phone:760-969-7770
Practice Address - Fax:760-969-7771
Is Sole Proprietor?:No
Enumeration Date:2006-03-26
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC160597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ153705OtherMEDICARE NUMBER
AZZ153705OtherMEDICARE NUMBER