Provider Demographics
NPI:1467475244
Name:KHAN, KHURSHID A (MD)
Entity Type:Individual
Prefix:DR
First Name:KHURSHID
Middle Name:A
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 1:2540 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6306
Mailing Address - Country:US
Mailing Address - Phone:972-686-4500
Mailing Address - Fax:
Practice Address - Street 1:2540 N GALLOWAY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6306
Practice Address - Country:US
Practice Address - Phone:972-686-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXJ4654207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115422103Medicaid
TX115422103Medicaid
TX85V261Medicare PIN