Provider Demographics
NPI:1528028032
Name:KHAN, MOHAMMAD SARFARAZ ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:SARFARAZ ALI
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:PO BOX 2755
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8175
Mailing Address - Country:US
Mailing Address - Phone:469-747-1010
Mailing Address - Fax:469-747-1014
Practice Address - Street 1:5501 INDEPENDENCE PKWY STE 302
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5470
Practice Address - Country:US
Practice Address - Phone:469-747-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI451262084P0800X
TXN51552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34399200Medicaid
WI34399200Medicaid
H88672Medicare UPIN
WI001884106Medicare UPIN