MEDICARE: DR. SEPEHR KHASHAEI MD

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	207R00000X	Internal Medicine Physician	MD2008-0054	NM

General Provider Information

NPI Number	:	1508845751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEPEHR KHASHAEI MD

Provider Business Mailing Address
First Line	:	2211 LOMAS BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-2745
Country	:	US
Telephone Number	:	505-272-2147
Fax Number	:	505-272-9437

Provider Business Practice Location Address
First Line	:	933 BRADBURY DR SE STE 2222
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4375
Country	:	US
Telephone Number	:	505-272-3120
Fax Number	:	505-272-8060

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

Provider Enumeration Date	:	01/15/2006
Last Update Date	:	05/03/2012

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