Provider Demographics
NPI:1003945221
Name:KHAN, ABDUL HAFEEZ (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:HAFEEZ
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9 CHATEAU MOUTON DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1902
Mailing Address - Country:US
Mailing Address - Phone:504-467-4547
Mailing Address - Fax:504-467-6999
Practice Address - Street 1:719 ELYSIAN FIELDS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-8511
Practice Address - Country:US
Practice Address - Phone:504-942-8101
Practice Address - Fax:504-942-8242
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0153682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1914967Medicaid
LA52853Medicare ID - Type Unspecified