Provider Demographics
NPI:1528399078
Name:SHAKIL A KHAN MD PC
Entity Type:Organization
Organization Name:SHAKIL A KHAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-838-2031
Mailing Address - Street 1:620 BAYHILL RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3308
Mailing Address - Country:US
Mailing Address - Phone:205-838-2031
Mailing Address - Fax:205-838-2073
Practice Address - Street 1:6869 5TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35212-1866
Practice Address - Country:US
Practice Address - Phone:205-838-2031
Practice Address - Fax:205-838-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL210662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG57072Medicare UPIN