Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 42325 | MN |
NPI | 1073557641 |
---|---|
Provider Name | Asim Said Khan |
First Address | Maple Grove, MN 55369-4768 |
Second Address | Maple Grove, MN 55369-4768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
460008800 | (05) | MN |
G03262 | (02) |