Provider Demographics
NPI:1427248988
Name:ALIKHAN, MIRZA ALI (MD)
Entity type:Individual
Prefix:
First Name:MIRZA
Middle Name:ALI
Last Name:ALIKHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:ALIKHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLER ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:1020 29TH STREET
Practice Address - Street 2:SUITE 570B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5125
Practice Address - Country:US
Practice Address - Phone:916-733-3792
Practice Address - Fax:916-733-8250
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104996207N00000X
MN53257207N00000X
OH35.121766207N00000X
390200000X
CAA149786207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00909063OtherRAILROAD MEDICARE
MNENROLLEDMedicaid
MNP00909063OtherRAILROAD MEDICARE