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General NPI Number Information
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NPI Number | 1326669805
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Entity Type | Organization
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Legal Business Name | MIDWEST GASTROENTEROLOGY PC
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 1200 S COLUMBIA RD
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City | GRAND FORKS
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State | ND
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Zip | 58201-4036
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Country | US
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Telephone | 701-780-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 WHITING RD NW UNIT 54
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City | BEMIDJI
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State | MN
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Zip | 56601-6629
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Country | US
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Telephone | 630-901-4143
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Fax |
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Authorized Official
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Title or Position | GASTROENTEROLOGY
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Name | FAIZAN ALI KHAN
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Credential | DO
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Telephone | 630-901-4143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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