Provider Demographics
NPI:1376528406
Name:ADNAN, KHAN (MD)
Entity Type:Individual
Prefix:
First Name:KHAN
Middle Name:
Last Name:ADNAN
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:PO BOX 10549
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-0549
Mailing Address - Country:US
Mailing Address - Phone:727-824-8100
Mailing Address - Fax:727-824-8166
Practice Address - Street 1:1020 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3423
Practice Address - Country:US
Practice Address - Phone:727-461-1439
Practice Address - Fax:727-443-7230
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71902208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253057100Medicaid
FL253057100Medicaid
41921Medicare ID - Type Unspecified