Provider Demographics
NPI:1578527727
Name:KHAN, MOHAMMAD N (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:N
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 1:1600 REPUBLIC PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6918
Mailing Address - Country:US
Mailing Address - Phone:972-270-7005
Mailing Address - Fax:972-270-7003
Practice Address - Street 1:1600 REPUBLIC PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6918
Practice Address - Country:US
Practice Address - Phone:972-270-7005
Practice Address - Fax:972-270-7003
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9129207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXG17209Medicare UPIN