Organization
AVICENNA MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MUJTABA ALI-KHAN D.O. (OWNER)
(855) 372-5454
Entity
Organization
Contact information
Practice address
504 MEDICAL CENTER BLVD, CONROE, TX 77304-2808
(855) 372-5454
(281) 408-4108
Mailing address
PO BOX 132921, SPRING, TX 77393-2921
(855) 372-5454
(936) 585-4657
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
M3450
TX
Other
Enumeration date
12/23/2008
Last updated
08/19/2011
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