Provider Demographics
NPI:1073504684
Name:KHAN, MUNEER AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:MUNEER
Middle Name:AHMAD
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 1:4345 W MEMORIAL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1702
Mailing Address - Country:US
Mailing Address - Phone:405-951-4160
Mailing Address - Fax:405-951-4162
Practice Address - Street 1:4345 W MEMORIAL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1702
Practice Address - Country:US
Practice Address - Phone:405-951-4160
Practice Address - Fax:405-951-4162
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27320207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51532859Medicaid
NM51532859Medicaid