Provider Demographics
NPI:1184663817
Name:KHAN, VAJIH M
Entity Type:Individual
Prefix:DR
First Name:VAJIH
Middle Name:M
Last Name:KHAN
Suffix:
Gender:M
Credentials:
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 160635
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-0635
Mailing Address - Country:US
Mailing Address - Phone:407-265-4801
Mailing Address - Fax:407-767-5983
Practice Address - Street 1:585 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6322
Practice Address - Country:US
Practice Address - Phone:407-265-4801
Practice Address - Fax:407-767-5983
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0031143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042053101Medicaid
FL47321 AND 47321ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL042053101Medicaid