Provider Demographics
NPI:1821054008
Name:ALIKHAN, MIR A (MD)
Entity Type:Individual
Prefix:
First Name:MIR A
Middle Name:
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 1:5055 S CONGRESS AVE
Mailing Address - Street 2:STE 303
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4722
Mailing Address - Country:US
Mailing Address - Phone:561-968-1100
Mailing Address - Fax:561-968-1106
Practice Address - Street 1:5055 S CONGRESS AVE
Practice Address - Street 2:STE 303
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4722
Practice Address - Country:US
Practice Address - Phone:561-968-1100
Practice Address - Fax:561-968-1106
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047934207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D61496Medicare UPIN
FL07348AMedicare ID - Type Unspecified