Provider Demographics
NPI:1659530343
Name:KHAN, MUHAMMAD ASAD (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:ASAD
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 1:104 UNION AVE STE 1005
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1846
Mailing Address - Country:US
Mailing Address - Phone:315-424-0790
Mailing Address - Fax:315-475-0916
Practice Address - Street 1:104 UNION AVE STE 1005
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1846
Practice Address - Country:US
Practice Address - Phone:315-424-0790
Practice Address - Fax:315-475-0916
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0034482086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03165982Medicaid
NYJ400011264Medicare PIN