Healthcare Provider Details

I. General information

NPI: 1497422307
Provider Name (Legal Business Name): MUHAMMAD KHALID TAHIR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 BARD AVENUE STATEN ISLAND
NEW YORK NY
10310-1699
US

IV. Provider business mailing address

900 E BROADWAY AVE
BISMARCK ND
58501-4520
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-1645
  • Fax: 718-818-3225
Mailing address:
  • Phone: 701-530-7000
  • Fax: 701-530-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number22944
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: