Provider Demographics
NPI:1417189671
Name:KHAN, ZEESHAN TARIQ (MD)
Entity Type:Individual
Prefix:DR
First Name:ZEESHAN
Middle Name:TARIQ
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 1:14100 SAN PEDRO AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2009
Mailing Address - Country:US
Mailing Address - Phone:210-543-7334
Mailing Address - Fax:210-314-5044
Practice Address - Street 1:6520 N PRESIDENT GEORGE BUSH HWY STE 100
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044
Practice Address - Country:US
Practice Address - Phone:972-532-9967
Practice Address - Fax:210-314-5044
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60278638208000000X, 208M00000X
OK37277207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1417189671Medicaid
WA025904OtherKRMC L&I GROUP NUMBER