Provider Demographics
NPI:1275837080
Name:AWAN, KHURRAM SHAHZAD (DO)
Entity Type:Individual
Prefix:DR
First Name:KHURRAM
Middle Name:SHAHZAD
Last Name:AWAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15801 WILLETS POINT BLVD.
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3934
Mailing Address - Country:US
Mailing Address - Phone:718-767-3055
Mailing Address - Fax:
Practice Address - Street 1:2552 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3777
Practice Address - Country:US
Practice Address - Phone:718-777-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-08
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine