Provider Demographics
NPI:1083657035
Name:KHAN, JAWAD H (MD)
Entity Type:Individual
Prefix:
First Name:JAWAD
Middle Name:H
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:
Practice Address - Street 1:3001 SANFORD PKWY
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2700
Practice Address - Country:US
Practice Address - Phone:218-681-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22934OtherNDBS #
MN1783340OtherAMERICA'S PPO/ARAZ #
MN137046OtherUCARE #
MN67G53KHOtherMNBS #
MNHP38672OtherHEALTHPARTNERS #
MN0405282OtherMEDICA #
MNMN100049OtherLHS/BANNERHEALTH #
MNDA9021034880OtherPREFERRED ONE #
MN12528Medicaid
MN938140600Medicaid
MN110011636Medicare PIN
MNDA9021034880OtherPREFERRED ONE #
MNHP38672OtherHEALTHPARTNERS #