Provider Demographics
NPI:1710902564
Name:KHAN, ABDUL S (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:S
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 E GRAND RESERVE
Mailing Address - Street 2:#1422
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-6216
Mailing Address - Country:US
Mailing Address - Phone:727-447-5454
Mailing Address - Fax:727-441-4782
Practice Address - Street 1:2707 E GRAND RESERVE CIR
Practice Address - Street 2:APT 1422
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4908
Practice Address - Country:US
Practice Address - Phone:727-447-5454
Practice Address - Fax:727-441-4782
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0083644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH56216Medicare UPIN
71405Medicare ID - Type Unspecified