Basic Information
| Provider Information | |||||||||
| NPI: | 1568694503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHOUKAZ | ||||||||
| FirstName: | MAYA | ||||||||
| MiddleName: | TONY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 LEBANON RD | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371291237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158676000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3400 LEBANON RD | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371291237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158676000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2009 | ||||||||
| LastUpdateDate: | 04/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 2009017788 | MO | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 051516 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.