Provider Demographics
NPI:1679545164
Name:KHAWAJA, IMRAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:R
Last Name:KHAWAJA
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 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9175
Mailing Address - Country:US
Mailing Address - Phone:214-645-5777
Mailing Address - Fax:214-645-6757
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9175
Practice Address - Country:US
Practice Address - Phone:214-645-5777
Practice Address - Fax:214-645-6757
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5663207R00000X
TXN2146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6005110Medicaid
SD6005110Medicaid
SD136409Medicare UPIN