MEDICARE: DR. KHURRAM MUMTAZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	C153915	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093979437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHURRAM MUMTAZ M.D.

Provider Business Mailing Address
First Line	:	2450 ORO DAM BLVD E
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6052
Country	:	US
Telephone Number	:	530-712-2171
Fax Number	:	530-712-2149

Provider Business Practice Location Address
First Line	:	2450 ORO DAM BLVD E
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6052
Country	:	US
Telephone Number	:	530-712-2171
Fax Number	:	530-712-2149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	05/14/2025

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