Provider Demographics
NPI:1962662510
Name:AMBREEN KHURSHID, M.D., INC.
Entity Type:Organization
Organization Name:AMBREEN KHURSHID, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-673-4000
Mailing Address - Street 1:451 E ALMOND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5562
Mailing Address - Country:US
Mailing Address - Phone:559-673-4000
Mailing Address - Fax:559-673-3661
Practice Address - Street 1:451 E ALMOND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5562
Practice Address - Country:US
Practice Address - Phone:559-673-4000
Practice Address - Fax:559-673-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52016207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAW835AMedicare PIN
CAG94089Medicare UPIN