Provider Demographics
NPI:1790747921
Name:ALIKHAN, MIR Z (MD)
Entity Type:Individual
Prefix:
First Name:MIR
Middle Name:Z
Last Name:ALIKHAN
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 1:2722 OSLER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2517
Mailing Address - Country:US
Mailing Address - Phone:979-776-8291
Mailing Address - Fax:979-774-7871
Practice Address - Street 1:2722 OSLER BLVD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2517
Practice Address - Country:US
Practice Address - Phone:979-776-8291
Practice Address - Fax:979-774-7871
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK79712085N0904X
TXP91972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118712204Medicaid
085358RMedicare ID - Type Unspecified