Provider Demographics
NPI:1164498051
Name:KHAN, ADNAN (MD)
Entity Type:Individual
Prefix:
First Name:ADNAN
Middle Name:
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 3228
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-3228
Mailing Address - Country:US
Mailing Address - Phone:407-448-7136
Mailing Address - Fax:407-347-0570
Practice Address - Street 1:2716 REW CIR
Practice Address - Street 2:SUUITE 100
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4201
Practice Address - Country:US
Practice Address - Phone:407-347-0666
Practice Address - Fax:407-347-0570
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84875207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268378400Medicaid
FL288980OtherAVMED
FL81888OtherBCBS
FLP00062172OtherRR MEDICARE
FLP00062172OtherRR MEDICARE
FL288980OtherAVMED
U0790VMedicare PIN