Provider Demographics
NPI:1568490183
Name:KHAN, SHUJATH A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUJATH
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8121 NATIONAL AVE
Mailing Address - Street 2:SUIT 401
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7530
Mailing Address - Country:US
Mailing Address - Phone:405-732-6223
Mailing Address - Fax:405-741-0414
Practice Address - Street 1:8121 NATIONAL AVE
Practice Address - Street 2:SUIT 401
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7530
Practice Address - Country:US
Practice Address - Phone:405-732-6223
Practice Address - Fax:405-741-0414
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK13081207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1568490183OtherBLUE CROSS BLUE SHIELD
OK1568490183OtherRAILROAD MEDICARE
OK100018820AMedicaid
OK100018820AMedicaid
OKD34893Medicare UPIN