Healthcare Provider Details

I. General information

NPI: 1013263763
Provider Name (Legal Business Name): MUSA KHALIQI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E WILLIAMS AVE
FALLON NV
89406-3052
US

IV. Provider business mailing address

4790 CAUGHLIN PKWY # 451
RENO NV
89519-0907
US

V. Phone/Fax

Practice location:
  • Phone: 775-423-3151
  • Fax:
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number13252
License Number StateNV

VIII. Authorized Official

Name: LORI LABRECQUE
Title or Position: ACCTS MGR
Credential:
Phone: 702-453-3799