Provider Demographics
NPI:1790745875
Name:KHAN, SAQIB B (MD)
Entity Type:Individual
Prefix:DR
First Name:SAQIB
Middle Name:B
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:PO BOX 100910
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4548
Mailing Address - Country:US
Mailing Address - Phone:863-682-7246
Mailing Address - Fax:
Practice Address - Street 1:541 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5228
Practice Address - Country:US
Practice Address - Phone:863-682-7246
Practice Address - Fax:863-683-7256
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070224207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG63123Medicare UPIN