Provider Demographics
NPI:1417968314
Name:KHAN, SHAHID I (MD)
Entity Type:Individual
Prefix:
First Name:SHAHID
Middle Name:I
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:PO BOX 2044
Mailing Address - Street 2:DEPT 4300
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-2044
Mailing Address - Country:US
Mailing Address - Phone:901-507-6600
Mailing Address - Fax:901-507-6599
Practice Address - Street 1:1211 UNION AVE
Practice Address - Street 2:STE 495
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6656
Practice Address - Country:US
Practice Address - Phone:901-507-6600
Practice Address - Fax:901-507-6599
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000028889207RC0000X, 246XC2901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723803Medicaid
TN3723803Medicaid