Healthcare Provider Details

I. General information

NPI: 1720058928
Provider Name (Legal Business Name): MUHAMMAD A KHALID DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE SUITE 103
WASHINGTON DC
20020-7024
US

IV. Provider business mailing address

2041 MARTIN LUTHER KING JR AVE SE SUITE 103
WASHINGTON DC
20020-7024
US

V. Phone/Fax

Practice location:
  • Phone: 202-889-6020
  • Fax: 202-889-6021
Mailing address:
  • Phone: 202-889-6020
  • Fax: 202-889-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO478
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: