Healthcare Provider Details

I. General information

NPI: 1255662250
Provider Name (Legal Business Name): DR. MATTHEW KHUMALO, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2982 E LOWELL AVE
GILBERT AZ
85295-1403
US

IV. Provider business mailing address

2982 E LOWELL AVE
GILBERT AZ
85295-1403
US

V. Phone/Fax

Practice location:
  • Phone: 480-238-7621
  • Fax: 620-647-4819
Mailing address:
  • Phone: 480-238-7621
  • Fax: 620-647-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37296
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number37296
License Number StateAZ

VIII. Authorized Official

Name: DR. MATTHEW KHUMALO
Title or Position: CEO/MEDICAL DIRECTOR
Credential: M.D.
Phone: 480-857-0109