Provider Demographics
NPI:1689644114
Name:KHAN, SHAHZAD M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHZAD
Middle Name:M
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 1:1125 ASPIRA CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-4125
Mailing Address - Country:US
Mailing Address - Phone:419-756-2122
Mailing Address - Fax:419-756-8456
Practice Address - Street 1:1125 ASPIRA CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4125
Practice Address - Country:US
Practice Address - Phone:419-756-2122
Practice Address - Fax:419-756-8456
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082191K207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2401903Medicaid
OH4104991Medicare PIN
OHG49462Medicare UPIN
OH4393220001Medicare NSC
OHP00032415Medicare PIN
OH4104992Medicare PIN
OH2401903Medicaid