Provider Demographics
NPI:1659374866
Name:KHAN, MOHAMMAD BABAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:BABAR
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 1:1900 W CHANDLER BLVD
Mailing Address - Street 2:PO BOX 15-336
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8632
Mailing Address - Country:US
Mailing Address - Phone:480-722-0239
Mailing Address - Fax:
Practice Address - Street 1:3195 S PRICE RD STE 150
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248
Practice Address - Country:US
Practice Address - Phone:480-678-0796
Practice Address - Fax:480-722-0240
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYD597882084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH87670Medicare UPIN