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General NPI Number Information
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NPI Number | 1730162108
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Entity Type | Individual
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Provider Name | KHAJA G MOHSIN MD
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Gender | Male
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 01/16/2015
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Provider Practice Location Address
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Address Line | 10 EMERALD TER
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City | SWANSEA
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State | IL
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Zip | 62226-2310
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Country | US
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Telephone | 618-235-6780
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Fax | 618-235-6740
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Provider Business Mailing Address
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Address Line | 11 WILLIAMSBURG ESTATES DR
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1019
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Country | US
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Telephone | 314-705-1762
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Fax | 618-235-6740
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036112195
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License Number State | IL
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