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1831290923 NPI number — MIR MUJTABA ALI KHAN D.O.

NPI Number: 1831290923
Health Care Provider/Practitioner: MIR MUJTABA ALI KHAN D.O.

Information about “1831290923” NPI (MIR MUJTABA ALI KHAN D.O.) exists in 1831290923 in HTML format HTML  |  1831290923 in plain Text format TXT  |  1831290923 in PDF (Portable Document Format) PDF  |  1831290923 in an XML format XML  formats.

NPI Number : 1831290923 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1831290923",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ALI KHAN",
    "FirstName": "MIR",
    "MiddleName": "MUJTABA",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.O.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ALI-KHAN",
    "OtherFirstName": "MUJTABA",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "D.O.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "179 INTERSTATE 45 S",
    "SecondLineMailingAddress": "SUITE 300",
    "MailingAddressCityName": "HUNTSVILLE",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77340-4223",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "936-294-0152",
    "MailingAddressFaxNumber": "936-294-9600",
    "FirstLinePracticeLocationAddress": "179 INTERSTATE 45 S",
    "SecondLinePracticeLocationAddress": "SUITE 300",
    "PracticeLocationAddressCityName": "HUNTSVILLE",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77340-4223",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "936-294-0152",
    "PracticeLocationAddressFaxNumber": "936-294-9600",
    "EnumerationDate": "09/25/2006",
    "LastUpdateDate": "05/30/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": "M3450",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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