Provider Demographics
NPI:1093812455
Name:KHAN, AHMED I (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:I
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 1:2919 S HAMPTON RD
Mailing Address - Street 2:F222
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-3026
Mailing Address - Country:US
Mailing Address - Phone:214-330-5007
Mailing Address - Fax:214-221-5600
Practice Address - Street 1:2919 S HAMPTON RD
Practice Address - Street 2:F222
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3026
Practice Address - Country:US
Practice Address - Phone:214-330-5007
Practice Address - Fax:214-221-5600
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0073207R00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032711604Medicaid
TX032711602Medicaid
TX8W5530OtherBCBS TX
P00272575OtherTX RAILROAD MEDICARE
TX8F5802Medicare PIN
P00272575OtherTX RAILROAD MEDICARE
TX8W5530OtherBCBS TX
TX8F2040Medicare PIN
C49579Medicare UPIN
TX032711602Medicaid