MEDICARE: MUHAMMAD KHALID TAHIR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1497422307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUHAMMAD KHALID TAHIR

Provider Business Mailing Address
First Line	:	255 BARD AVENUE STATEN ISLAND
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10310-1699
Country	:	US
Telephone Number	:	718-818-1645
Fax Number	:	718-818-3225

Provider Business Practice Location Address
First Line	:	255 BARD AVENUE STATEN ISLAND
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10310-1699
Country	:	US
Telephone Number	:	718-818-1645
Fax Number	:	718-818-3225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2021
Last Update Date	:	08/27/2021

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