Provider Demographics
NPI:1700846169
Name:KHAN, TARIQ A (MD)
Entity Type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:A
Last Name:KHAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 122108
Mailing Address - Street 2:DEPT 2108
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2108
Mailing Address - Country:US
Mailing Address - Phone:337-475-8100
Mailing Address - Fax:337-475-8510
Practice Address - Street 1:1717 OAK PARK BLVD
Practice Address - Street 2:3RD FL
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8991
Practice Address - Country:US
Practice Address - Phone:337-475-8100
Practice Address - Fax:337-475-8510
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-06-02
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Provider Licenses
StateLicense IDTaxonomies
LA12962R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1670936Medicaid
5E682Medicare PIN
LAG96662Medicare UPIN