Healthcare Provider Details

I. General information

NPI: 1124409073
Provider Name (Legal Business Name): MUHAMMAD OSMAN SALIM KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 08/09/2020
Certification Date: 08/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 S MERCY RD STE 101
GILBERT AZ
85297-0441
US

IV. Provider business mailing address

3507 S MERCY RD STE 101
GILBERT AZ
85297-0441
US

V. Phone/Fax

Practice location:
  • Phone: 480-926-0644
  • Fax: 480-926-0645
Mailing address:
  • Phone: 480-926-0644
  • Fax: 480-926-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number5101021981
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: