Provider Demographics
NPI:1487689808
Name:KHAN, ATEEQUE R (MD)
Entity Type:Individual
Prefix:DR
First Name:ATEEQUE
Middle Name:R
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 552318
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33655-0001
Mailing Address - Country:US
Mailing Address - Phone:904-599-3225
Mailing Address - Fax:904-281-9806
Practice Address - Street 1:4466 SWILCAN BRIDGE LN N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-5617
Practice Address - Country:US
Practice Address - Phone:904-599-3225
Practice Address - Fax:904-821-8050
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222724207R00000X
FLME97554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH49858Medicare UPIN
NY50S541Medicare ID - Type UnspecifiedMEDICARE