Basic Information
| Provider Information | |||||||||
| NPI: | 1427248988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALIKHAN | ||||||||
| FirstName: | MIRZA | ||||||||
| MiddleName: | ALI | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ALIKHAN | ||||||||
| OtherFirstName: | ALI | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10470 OLD PLACERVILLER ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958272539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004700071 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1020 29TH STREET | ||||||||
| Address2: | SUITE 570B | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167333792 | ||||||||
| FaxNumber: | 9167338250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 104996 | MN | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 53257 | MN | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 35.121766 | OH | N | Allopathic & Osteopathic Physicians | Dermatology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207N00000X | A149786 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | P00909063 | 01 | MN | RAILROAD MEDICARE | OTHER | ENROLLED | 05 | MN | MEDICAID |