| Khakwani And Mohammad Medical Pc | |
|
3540 E Baseline Rd Ste 130 Phoenix AZ 85042-9629 | |
| (623) 257-7559 | |
| Not Available |
| Full Name | Khakwani And Mohammad Medical Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 3540 E Baseline Rd Ste 130, Phoenix, Arizona |
| Authorized Official Name and Position | Valerie Denise Estrada (CREDENTIALING MANAGER) |
| Authorized Official Contact | 4697182768 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Khakwani And Mohammad Medical Pc Po Box 660047 Dallas TX 75266-2900 Ph: (702) 820-5713 | Khakwani And Mohammad Medical Pc 3540 E Baseline Rd Ste 130 Phoenix AZ 85042-9629 Ph: (623) 257-7559 |
| NPI Number | 1518672278 |
|---|---|
| Provider Enumeration Date | 01/17/2023 |
| Last Update Date | 03/26/2025 |
| Medicare PECOS PAC ID | 8527412659 |
|---|---|
| Medicare Enrollment ID | O20230923000296 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518672278 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Muhammad Vikas Ahmad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104921048 PECOS PAC ID: 5991702763 Enrollment ID: I20061109000130 |
| Provider Name | Sultan Mohammad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760699888 PECOS PAC ID: 3779675749 Enrollment ID: I20080312000479 |
| Provider Name | Harris Khakwani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134322498 PECOS PAC ID: 2769537588 Enrollment ID: I20090831000579 |
| Provider Name | Audra Corona Ibarra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700432622 PECOS PAC ID: 8022340066 Enrollment ID: I20191024001868 |
| Provider Name | Diana Phuong Thai |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952863862 PECOS PAC ID: 1850771841 Enrollment ID: I20220708000271 |
| Provider Name | Catherine Elizabeth Zotovich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114685393 PECOS PAC ID: 0143664714 Enrollment ID: I20240222001527 |
| Provider Name | Kelsey Lynn De Villiers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669222865 PECOS PAC ID: 0749723823 Enrollment ID: I20240617004102 |
| Provider Name | Suzanne Marie Chang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386486371 PECOS PAC ID: 7214475144 Enrollment ID: I20240809003300 |
| Provider Name | Natalisse Wahlstrom-davila |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366145591 PECOS PAC ID: 9032639596 Enrollment ID: I20250227000845 |
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