Provider Demographics
NPI:1225774284
Name:KHAN, ABDUL WALI (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL WALI
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 1:2301 HOLMES STREET, UNIVERSITY HEALTH- TRUMAN MEDICAL C
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108
Mailing Address - Country:US
Mailing Address - Phone:816-404-4175
Mailing Address - Fax:816-404-0003
Practice Address - Street 1:2301 HOLMES STREET, UNIVERSITY HEALTH- TRUMAN MEDICAL C
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108
Practice Address - Country:US
Practice Address - Phone:816-404-4175
Practice Address - Fax:816-404-0003
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2023-08-09
Deactivation Date:2022-12-27
Deactivation Code:
Reactivation Date:2023-08-09
Provider Licenses
StateLicense IDTaxonomies
MO390200000X
MO2023019625390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program