Organization
KHOUKAZ INTERNAL MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GHASSAN KHOUKAZ MD (OWNER OF PRACTICE)
(314) 577-5778
Entity
Organization
Contact information
Practice address
3915 WATSON RD, SUITE 100, SAINT LOUIS, MO 63109-1251
(314) 646-0478
(314) 646-0698
Mailing address
1836 LACKLAND HILL PKWY, SAINT LOUIS, MO 63146-3572
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2005005178
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DF6432
RR MEDICARE GROUP#
MO
Enumeration date
02/03/2006
Last updated
10/17/2007
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