Healthcare Provider Details

I. General information

NPI: 1174841035
Provider Name (Legal Business Name): MOHAMED KHALID MUNSHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 KIRKVILLE RD STE 203
EAST SYRACUSE NY
13057-9313
US

IV. Provider business mailing address

6700 KIRKVILLE RD STE 203
EAST SYRACUSE NY
13057-9313
US

V. Phone/Fax

Practice location:
  • Phone: 315-277-2707
  • Fax: 315-433-5100
Mailing address:
  • Phone: 315-277-2707
  • Fax: 315-433-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number288105
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number288105
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number288105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: