Provider Demographics
NPI:1821054453
Name:KHAN, AZHAR ULLAH (MD)
Entity Type:Individual
Prefix:
First Name:AZHAR
Middle Name:ULLAH
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 1:3366 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 660
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4462
Mailing Address - Country:US
Mailing Address - Phone:405-947-3345
Mailing Address - Fax:405-946-6677
Practice Address - Street 1:3366 NW EXPRESSWAY STE 650
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4490
Practice Address - Country:US
Practice Address - Phone:405-947-3347
Practice Address - Fax:405-947-4232
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19711207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK290012708OtherRAILROAD MEDICARE
OK100226590AMedicaid
OK290012708OtherRAILROAD MEDICARE
OKG26911Medicare UPIN