Basic Information
Provider Information
NPI: 1003011396
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AMIN
FirstName: KHALID
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 420 DELAWARE ST SE
Address2: C463 MAYO MEMORIAL BLDG, MAYO MAIL CODE 76
City: MINNEAPOLIS
State: MN
PostalCode: 554550341
CountryCode: US
TelephoneNumber: 9138273505
FaxNumber:  
Practice Location
Address1: 420 DELAWARE ST SE
Address2: C463 MAYO MEMORIAL BLDG, MAYO MAIL CODE 76
City: MINNEAPOLIS
State: MN
PostalCode: 554550341
CountryCode: US
TelephoneNumber: 9138273505
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/18/2007
LastUpdateDate: 03/03/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZC0500X55541MNN Allopathic & Osteopathic PhysiciansPathologyCytopathology
207ZP0102X55541MNY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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