Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 47521 | MN |
NPI | 1093702235 |
---|---|
Provider Name | Asma Khalid |
First Address | Boston, MA 02114-2438 |
Second Address | Le Sueur, MN 56058-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
IO9995 | (02) | MN |