Provider Demographics
NPI:1730162108
Name:MOHSIN, KHAJA G (MD)
Entity type:Individual
Prefix:
First Name:KHAJA
Middle Name:G
Last Name:MOHSIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11 WILLIAMSBURG ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1019
Mailing Address - Country:US
Mailing Address - Phone:314-705-1762
Mailing Address - Fax:618-235-6740
Practice Address - Street 1:10 EMERALD TER
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2310
Practice Address - Country:US
Practice Address - Phone:618-235-6780
Practice Address - Fax:618-235-6740
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2015-01-16
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Provider Licenses
StateLicense IDTaxonomies
IL036112195207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK24889Medicare PIN