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General NPI Number Information
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NPI Number | 1831586247
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Entity Type | Organization
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Legal Business Name | DR ALI KHOJASTEH MEDEXCELLENCE LLC
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Dates
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Enumeration Date | 04/23/2015
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 500 N KEENE ST SUITE 202
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City | COLUMBIA
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State | MO
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Zip | 65201-8104
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Country | US
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Telephone | 573-442-6800
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Fax | 573-449-4943
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Provider Business Mailing Address
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Address Line | 500 N KEENE ST STE 202
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City | COLUMBIA
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State | MO
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Zip | 65201-8104
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Country | US
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Telephone | 573-442-6800
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Fax | 573-449-4943
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ALI KHOJASTEH
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Credential | MD
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Telephone | 573-442-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R9764
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License Number State | MO
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