Provider Demographics
NPI:1598791303
Name:KHAN, FAISAL HAMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:HAMAD
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 1:2010 CHESTNUT ST
Mailing Address - Street 2:STE H
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5340
Mailing Address - Country:US
Mailing Address - Phone:479-471-4280
Mailing Address - Fax:918-967-8462
Practice Address - Street 1:2010 CHESTNUT ST
Practice Address - Street 2:STE H
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5321
Practice Address - Country:US
Practice Address - Phone:479-471-4280
Practice Address - Fax:918-967-8462
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24345174400000X
ARE-10046208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200048940BMedicaid
OKI46683Medicare UPIN
AR550898YH5HMedicare PIN
OK245534312Medicare Oscar/Certification