Provider Demographics
NPI:1093794935
Name:KHAN, ANSAR U (MD)
Entity Type:Individual
Prefix:
First Name:ANSAR
Middle Name:U
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 1:2735 N CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025
Mailing Address - Country:US
Mailing Address - Phone:402-727-5000
Mailing Address - Fax:402-727-5055
Practice Address - Street 1:2735 N CLARKSON ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025
Practice Address - Country:US
Practice Address - Phone:402-727-5000
Practice Address - Fax:402-727-5055
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15471208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063180113Medicaid
NE47063180113Medicaid
092199Medicare ID - Type Unspecified