Provider Demographics
NPI:1558429282
Name:MUHAMMAD Y KHAN MD SC
Entity Type:Organization
Organization Name:MUHAMMAD Y KHAN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUAHMMAD
Authorized Official - Middle Name:YOUSAF
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD SC
Authorized Official - Phone:414-271-1900
Mailing Address - Street 1:1218 W KILBOURN AVE
Mailing Address - Street 2:#409
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1330
Mailing Address - Country:US
Mailing Address - Phone:414-271-1900
Mailing Address - Fax:414-271-8087
Practice Address - Street 1:1218 W KILBOURN AVE
Practice Address - Street 2:STE 409
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233
Practice Address - Country:US
Practice Address - Phone:414-271-1900
Practice Address - Fax:414-271-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30887200Medicaid
WIB84975Medicare UPIN
WI000001143Medicare PIN