Provider Demographics
NPI:1497937890
Name:KHAN, MANSOOR A (MD)
Entity Type:Individual
Prefix:
First Name:MANSOOR
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 1:4411 WASHINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0805
Mailing Address - Country:US
Mailing Address - Phone:414-455-1153
Mailing Address - Fax:823-523-9918
Practice Address - Street 1:4411 WASHINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0890
Practice Address - Country:US
Practice Address - Phone:888-901-7246
Practice Address - Fax:877-598-6856
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065991A208VP0014X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation