Provider Demographics
NPI:1619975141
Name:KHAN, TEHREEN (MD)
Entity Type:Individual
Prefix:
First Name:TEHREEN
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 EICHENFELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5908
Mailing Address - Country:US
Mailing Address - Phone:813-684-6000
Mailing Address - Fax:813-654-9032
Practice Address - Street 1:635 EICHENFELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5908
Practice Address - Country:US
Practice Address - Phone:813-684-6000
Practice Address - Fax:813-654-9032
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2022-07-21
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
FLME89025207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270428500Medicaid
FLK5306Medicare ID - Type Unspecified
FL270428500Medicaid