Individual provider Active NPI

Mohammad M Khaghany, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Kalamazoo, MI
National Provider Identifier
1790733129
Registry record updated Nov 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
039427 Issued in MI
Practice address
1722 Shaffer St
Suite 2
Kalamazoo, MI 49048-1633
Phone
(269) 343-1555
Fax
(269) 343-3209
NPI assigned
May 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 039427 MI Primary

Addresses

Primary practice location

1722 Shaffer St
Suite 2
Kalamazoo, MI 49048-1633

Mailing address

1722 Shaffer St
Suite 2
Kalamazoo, MI 49048-1633
Phone (269) 343-1555

Other identifiers 2

IdentifierTypeStateIssuer
4240560MedicaidMI
03931791OtherMIBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
039427MIMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194307200000",
    "number": "1790733129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 SHAFFER ST",
            "address_2": "SUITE 2",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481633",
            "telephone_number": "269-343-1555",
            "fax_number": "269-343-3209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1722 SHAFFER ST",
            "address_2": "SUITE 2",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481633",
            "telephone_number": "269-343-1555",
            "fax_number": "269-343-3209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAGHANY",
        "first_name": "MOHAMMAD",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2007-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MI",
            "license": "039427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4240560",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "03931791",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.