Provider Demographics
NPI:1255046918
Name:KHAKWANI AND MOHAMMAD MEDICAL PC
Entity type:Organization
Organization Name:KHAKWANI AND MOHAMMAD MEDICAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-718-2768
Mailing Address - Street 1:PO BOX 660047
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-2900
Mailing Address - Country:US
Mailing Address - Phone:702-820-5713
Mailing Address - Fax:
Practice Address - Street 1:1500 S WATSON RD STE 104
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-8690
Practice Address - Country:US
Practice Address - Phone:623-251-7559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KHAKWANI AND MOHAMMAD MEDICAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-17
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty