Provider Demographics
NPI:1295471530
Name:KHAN, TALHA MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:TALHA
Middle Name:MOHAMMAD
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 1:11100 EUCLID AVE
Mailing Address - Street 2:LAKESIDE BUILDING SUITE 6223
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106
Mailing Address - Country:US
Mailing Address - Phone:216-844-3944
Mailing Address - Fax:216-844-1949
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:BOLWELL SUITE 1200
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-3944
Practice Address - Fax:216-844-1949
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-12-28
Deactivation Date:2022-12-21
Deactivation Code:
Reactivation Date:2022-12-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program