Healthcare Provider Details

I. General information

NPI: 1407927130
Provider Name (Legal Business Name): KHALID M SHIRIF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N PASADENA ST
GILBERT AZ
85233-5013
US

IV. Provider business mailing address

105 N PASADENA ST
GILBERT AZ
85233-5013
US

V. Phone/Fax

Practice location:
  • Phone: 480-268-2670
  • Fax: 480-268-2671
Mailing address:
  • Phone: 480-268-2670
  • Fax: 480-268-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086H0002X
TaxonomyHospice and Palliative Medicine (Surgery) Physician
License Number38215
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number38215
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number38215
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: