Healthcare Provider Details

I. General information

NPI: 1780821546
Provider Name (Legal Business Name): KHAWAJA CONSULTING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 W CALLE ESCUDA
PHOENIX AZ
85085-8022
US

IV. Provider business mailing address

PO BOX 1149
PEORIA AZ
85380-1149
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-2073
  • Fax:
Mailing address:
  • Phone: 623-583-2073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number33750
License Number StateAZ

VIII. Authorized Official

Name: AZIMUDDIN T KHAWAJA
Title or Position: OWNER
Credential: M.D.
Phone: 623-583-2073