Provider Demographics
NPI:1467693317
Name:KHAN, SAFDAR GHAYUR (MD)
Entity Type:Individual
Prefix:
First Name:SAFDAR
Middle Name:GHAYUR
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 1:1000 BRECKENRIDGE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-0877
Mailing Address - Country:US
Mailing Address - Phone:270-685-7150
Mailing Address - Fax:270-685-7173
Practice Address - Street 1:1000 BRECKENRIDGE ST STE 300
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0877
Practice Address - Country:US
Practice Address - Phone:270-685-7150
Practice Address - Fax:270-685-7173
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42375207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000609731OtherANTHEM PIN # WITH CHS, INC.
KY7100093900Medicaid
KY7100093900Medicaid