Provider Demographics
NPI:1700933777
Name:A M KHOKHAR MEDICAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:A M KHOKHAR MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHOKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-769-9222
Mailing Address - Street 1:7899 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5284
Mailing Address - Country:US
Mailing Address - Phone:219-769-9222
Mailing Address - Fax:210-661-8892
Practice Address - Street 1:7899 TAFT ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5284
Practice Address - Country:US
Practice Address - Phone:219-769-9222
Practice Address - Fax:210-661-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027943207RE0101X
207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100166330AMedicaid
IN492420Medicare ID - Type Unspecified
IN100166330AMedicaid