Provider Demographics
NPI:1609059732
Name:KHAN, MISHAL SHOAIB (MD)
Entity Type:Individual
Prefix:DR
First Name:MISHAL
Middle Name:SHOAIB
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 HOSPITAL AVENUE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-798-0500
Mailing Address - Fax:203-798-0881
Practice Address - Street 1:27 HOSPITAL AVENUE
Practice Address - Street 2:SUITE 303
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-798-0500
Practice Address - Fax:203-798-0881
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT048631207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008032077Medicaid
CTD400051275Medicare PIN