Provider Demographics
NPI:1922751254
Name:MK ANESTHESIA SERVICES PLLC
Entity Type:Organization
Organization Name:MK ANESTHESIA SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-880-0023
Mailing Address - Street 1:2352 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6618
Mailing Address - Country:US
Mailing Address - Phone:917-880-0023
Mailing Address - Fax:
Practice Address - Street 1:2352 E 72ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6618
Practice Address - Country:US
Practice Address - Phone:917-880-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty