Provider Demographics
NPI:1407075021
Name:KHAN, MITCHELL ALAN (DO)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:ALAN
Last Name:KHAN
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 1:410 E ROBINSON ST
Mailing Address - Street 2:SUITE B2
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-2058
Mailing Address - Country:US
Mailing Address - Phone:641-842-3700
Mailing Address - Fax:641-842-3363
Practice Address - Street 1:410 E ROBINSON ST
Practice Address - Street 2:SUITE B2
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-2058
Practice Address - Country:US
Practice Address - Phone:641-842-3700
Practice Address - Fax:641-842-3363
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113101207V00000X
IA3794207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00404383OtherRAILROAD MEDICARE
IA03501OtherWELLMARK/BLUE CROSS/BLUE
IA1407075021Medicaid
IA03501OtherWELLMARK/BLUE CROSS/BLUE