Provider Demographics
NPI:1588613376
Name:KHAN, MUHAMMAD AMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:AMIR
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 1:3505 PROGRESS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6519
Mailing Address - Country:US
Mailing Address - Phone:407-891-8044
Mailing Address - Fax:407-891-8016
Practice Address - Street 1:3505 PROGRESS LN
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6519
Practice Address - Country:US
Practice Address - Phone:407-891-8044
Practice Address - Fax:407-891-8016
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255185300Medicaid
FLG63352Medicare UPIN
FL42276XMedicare ID - Type Unspecified