Provider Demographics
NPI:1013401462
Name:KHAN, MUHAMMAD IJLAL (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD IJLAL
Middle Name:
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 1:740 S LIMESTONE 2ND FLOOR WING C
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-257-8562
Mailing Address - Fax:859-257-7411
Practice Address - Street 1:740 S LIMESTONE 2ND FLOOR WING C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7408
Practice Address - Country:US
Practice Address - Phone:859-257-8562
Practice Address - Fax:859-257-7411
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1000X
KY54933261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health