Provider Demographics
NPI:1679626311
Name:KHAN, KHALIL (DO)
Entity Type:Individual
Prefix:
First Name:KHALIL
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2062
Mailing Address - Country:US
Mailing Address - Phone:954-474-9082
Mailing Address - Fax:954-763-3544
Practice Address - Street 1:1226 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-1507
Practice Address - Country:US
Practice Address - Phone:954-527-0222
Practice Address - Fax:954-763-3544
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine