Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 35.096184 | OH |
NPI | 1104873652 |
---|---|
Provider Name | Mustafa Khan |
First Address | Milwaukee, WI 53233-1325 |
Second Address | Milwaukee, WI 53233-1325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 11/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2746863 | (05) | OH |