Provider Demographics
NPI:1417924002
Name:KHAN, MUJEEB H (MD)
Entity Type:Individual
Prefix:
First Name:MUJEEB
Middle Name:H
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 1:9352 PARK WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4325
Mailing Address - Country:US
Mailing Address - Phone:865-373-1745
Mailing Address - Fax:865-373-1747
Practice Address - Street 1:9352 PARK WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4325
Practice Address - Country:US
Practice Address - Phone:865-373-1745
Practice Address - Fax:865-373-1747
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0359412084P0800X
FLME984042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280610000Medicaid
TNP00712608OtherRR MEDICARE
3872176Medicare ID - Type Unspecified
TNP00712608OtherRR MEDICARE
TNE25412Medicare UPIN