Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 5101021981 | MI |
NPI | 1124409073 |
---|---|
Provider Name | Muhammad Osman Salim Khan |
First Address | Gilbert, AZ 85297-0441 |
Second Address | Gilbert, AZ 85297-0441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2015 |
Last Update Date | 09/08/2020 |