Provider Demographics
NPI:1063670222
Name:KHAN, BILAL RAUF (MD)
Entity Type:Individual
Prefix:
First Name:BILAL
Middle Name:RAUF
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 1:1654 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3439
Mailing Address - Country:US
Mailing Address - Phone:478-225-9882
Mailing Address - Fax:478-293-1217
Practice Address - Street 1:1654 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3439
Practice Address - Country:US
Practice Address - Phone:478-225-9882
Practice Address - Fax:478-293-1217
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64122207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I060078Medicare PIN