Provider Demographics
NPI:1205817475
Name:KHAN, SHAHZAD (MD)
Entity Type:Individual
Prefix:
First Name:SHAHZAD
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 1:3385 BURNS RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4328
Mailing Address - Country:US
Mailing Address - Phone:561-627-0772
Mailing Address - Fax:561-537-7196
Practice Address - Street 1:3385 BURNS RD
Practice Address - Street 2:SUITE 208
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4328
Practice Address - Country:US
Practice Address - Phone:561-627-0772
Practice Address - Fax:561-537-7196
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2012-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93216207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275065100Medicaid
FL29438OtherBCBS
U5352AMedicare PIN
FL275065100Medicaid
FLU5352ZMedicare PIN