Provider Demographics
NPI:1093700627
Name:KHAN, RAFAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAY
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAFAY
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9028 GREAT HERON CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5483
Mailing Address - Country:US
Mailing Address - Phone:407-343-1221
Mailing Address - Fax:407-343-8228
Practice Address - Street 1:2497 TRAFALGAR BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-2551
Practice Address - Country:US
Practice Address - Phone:407-343-1221
Practice Address - Fax:407-343-8228
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30648174400000X
FLME99347208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3832208Medicaid
TNG86501Medicare UPIN