| Doctor Name: | DR. ALIREZA KHONSARI |
| NPI Number: | 1154392348 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 01033004A |
| Business Practice Address: | 710 North East Street Wabash County Hospital Wabash, IN - 46992 |
| Business Phone Number: | 2605692240 |
| Business Fax Number: | 2605692380 |
| Mailing Address: | 6119 W Jefferson Blvd, FORT WAYNE |
| State: | IN |
| Postal Code: | 46804 |
| Phone Number: | 2604321568 |
| Fax Number: | 2604324969 |
| NPI Enumeration Date: | 01/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | 01033004A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |