Provider Demographics
NPI:1629047162
Name:KHAN, ALAM N (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAM
Middle Name:N
Last Name:KHAN
Suffix:
Gender:M
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7325
Practice Address - Street 1:192 LONDON SHOPPING CTR
Practice Address - Street 2:STE 2
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3015
Practice Address - Country:US
Practice Address - Phone:606-877-6050
Practice Address - Fax:606-878-1125
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY334472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611427889OtherCHA
KY611427889OtherTRICARE
KY611427889OtherUHC
KY611427889OtherHUMANA
KY611427889OtherBLUEGRASS FAMILY HEALTH
KYC04254OtherCHI
KY000000506680OtherANTHEM
KYC05082OtherCHI
KY64324478Medicaid
KYC04254OtherCHI
KY0736566Medicare ID - Type UnspecifiedMEDICARE