Provider Demographics
NPI:1891291811
Name:KHALID, MAHVISH (MD)
Entity Type:Individual
Prefix:
First Name:MAHVISH
Middle Name:
Last Name:KHALID
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 1:60 MILL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2751
Mailing Address - Country:US
Mailing Address - Phone:630-346-9227
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST STE 2E
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:630-346-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program