Provider Demographics
NPI:1699851584
Name:KHAN, AFTAB A (MD)
Entity Type:Individual
Prefix:
First Name:AFTAB
Middle Name:A
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 1:2502 SAND MINE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-3402
Mailing Address - Country:US
Mailing Address - Phone:863-420-4077
Mailing Address - Fax:863-420-4087
Practice Address - Street 1:2502 SAND MINE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-3402
Practice Address - Country:US
Practice Address - Phone:863-420-4077
Practice Address - Fax:863-420-4087
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268397100Medicaid
FL81359OtherBCBS OF FL
FLH84703Medicare UPIN
FL268397100Medicaid