Provider Demographics
NPI:1255502498
Name:KHAGHANY, KAMRAN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:JOHN
Last Name:KHAGHANY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 S CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2913
Mailing Address - Country:US
Mailing Address - Phone:218-736-8000
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-3641
Practice Address - Country:US
Practice Address - Phone:701-234-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-16
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPT119152085R0202X
NC1341272085R0202X
MN586002085R0202X
ND119152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN716793Medicare PIN