Provider Demographics
NPI:1265478226
Name:KHAN, MOHAMMAD ASIM (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ASIM
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 1:3020 PARK POND WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7662
Mailing Address - Country:US
Mailing Address - Phone:407-978-6021
Mailing Address - Fax:407-978-6386
Practice Address - Street 1:3020 PARK POND WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7662
Practice Address - Country:US
Practice Address - Phone:407-978-6021
Practice Address - Fax:407-978-6386
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76641207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257403900Medicaid
FL257403900Medicaid
FLG20371Medicare UPIN