Provider Demographics
NPI:1528013059
Name:KHAN, MUSHTAQ HUSSAIN (MD)
Entity Type:Individual
Prefix:
First Name:MUSHTAQ
Middle Name:HUSSAIN
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 1:61 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8335
Mailing Address - Country:US
Mailing Address - Phone:716-866-8574
Mailing Address - Fax:716-689-4030
Practice Address - Street 1:61-LAUREL LANE
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-866-8574
Practice Address - Fax:716-689-4030
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188925-1207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services