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General NPI Number Information
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NPI Number | 1053239020
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Entity Type | Organization
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Legal Business Name | KHAKWANI AND MOHAMMAD MEDICAL PC
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Dates
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Enumeration Date | 07/08/2026
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Last Update Date | 07/08/2026
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Provider Practice Location Address
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Address Line | 1545 N VERRADO WAY STE 108B
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City | BUCKEYE
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State | AZ
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Zip | 85396-1868
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Country | US
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Telephone | 480-499-1539
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Fax | 480-566-2315
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Provider Business Mailing Address
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Address Line | PO BOX 660047
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City | DALLAS
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State | TX
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Zip | 75266-2900
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Country | US
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Telephone | 702-820-5713
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Fax | 775-467-2466
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Authorized Official
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Title or Position | MEDICAL CREDENTIALING MANAGER
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Name | SAM RICHARD ROY
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Credential |
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Telephone | 469-868-0730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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