Healthcare Provider Details

I. General information

NPI: 1750386173
Provider Name (Legal Business Name): KHALIDA DURRANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 NANTUCKETT DR STE C
TOLEDO OH
43623-3194
US

IV. Provider business mailing address

4235 SECOR RD
TOLEDO OH
43623
US

V. Phone/Fax

Practice location:
  • Phone: 419-720-7676
  • Fax: 419-720-7678
Mailing address:
  • Phone: 419-720-7676
  • Fax: 419-720-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35078646
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35078646
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: