Provider Demographics
NPI:1003981929
Name:KHAN, RIZWAN N (MD)
Entity Type:Individual
Prefix:
First Name:RIZWAN
Middle Name:N
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 N FEDERAL HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3236
Mailing Address - Country:US
Mailing Address - Phone:954-990-8134
Mailing Address - Fax:954-990-8634
Practice Address - Street 1:2137 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40210-2242
Practice Address - Country:US
Practice Address - Phone:502-712-1292
Practice Address - Fax:502-901-9955
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY302782081P2900X, 208VP0000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200210020Medicaid
IN200210020Medicaid
INF77482Medicare UPIN