Provider Demographics
NPI:1427021435
Name:KHAN, NEELAM RIAZ (MD)
Entity Type:Individual
Prefix:
First Name:NEELAM
Middle Name:RIAZ
Last Name:KHAN
Suffix:
Gender:F
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:PO BOX 850489
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-0489
Mailing Address - Country:US
Mailing Address - Phone:513-423-9492
Mailing Address - Fax:251-631-3361
Practice Address - Street 1:6801 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-639-5775
Practice Address - Fax:251-639-2664
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00027026207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51532127OtherBLUE CROSS BLUE SHIELD
AL511-42486OtherBLUE CROSS
AL158061Medicaid
AL158061Medicaid
AL102I082770Medicare PIN