Provider Demographics
NPI:1396825246
Name:KHAN, ASIF IQBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIF
Middle Name:IQBAL
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3040 BELMONT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1836
Mailing Address - Country:US
Mailing Address - Phone:330-759-3415
Mailing Address - Fax:330-759-9215
Practice Address - Street 1:3040 BELMONT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1836
Practice Address - Country:US
Practice Address - Phone:330-759-3415
Practice Address - Fax:330-759-9215
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH90106207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2767475Medicaid
OHKH4219011Medicare PIN