Healthcare Provider Details

I. General information

NPI: 1659049088
Provider Name (Legal Business Name): SAAD MUSTAFA KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010, HUCKELL PL SW
EDMONTO ALBERTA
T6W 3B7
CA

IV. Provider business mailing address

1010 HUCKELL PL SW
EDMONTON AB
T6W 3B7
CA

V. Phone/Fax

Practice location:
  • Phone: 780-680-7357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301069531
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: