Avicenna Medical Associates

Primary specialty

Hospitalist PhysicianTaxonomy code 208M00000X

License

M3450 Issued in TX

Legal business name

AVICENNA MEDICAL ASSOCIATES

Practice address

504 Medical Center Blvd
Conroe, TX 77304-2808

Phone

(855) 372-5454

Fax

(281) 408-4108

NPI assigned

Dec 23, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Mujtaba Ali-Khan, D.O.

Title

Owner

Phone

(855) 372-5454

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1229990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313712000000",
    "number": "1841436763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 132921",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773932921",
            "telephone_number": "855-372-5454",
            "fax_number": "936-585-4657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 MEDICAL CENTER BLVD",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042808",
            "telephone_number": "855-372-5454",
            "fax_number": "281-408-4108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVICENNA MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-23",
        "last_updated": "2011-08-19",
        "status": "A",
        "authorized_official_last_name": "ALI-KHAN",
        "authorized_official_first_name": "MUJTABA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "855-372-5454",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "M3450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Y Auces
• Audiology Partners of Texas, LLC
• Aurelia Health Services LLC
• Shanen Dorothy Ramos Aureus
• Avalon Adult Day Care Center
• Katherine Elise Avila
• Warren David Awalt, OD
• Ganiat Awofala, CRNP
• Blessing Awukam
• Nelda Marie Axley, M.A. LPC

• Hospitalist Physician in Conroe, TX
• Providers in Conroe, TX by specialty
• Hospitalist Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2011; 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.