Provider Demographics
NPI:1821183435
Name:KHAN, JALIL AZIZ (MD)
Entity Type:Individual
Prefix:
First Name:JALIL
Middle Name:AZIZ
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:502 NORTH VALLEY PARKWAY
Mailing Address - Street 2:1
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3437
Mailing Address - Country:US
Mailing Address - Phone:972-353-8616
Mailing Address - Fax:972-353-5352
Practice Address - Street 1:502 NORTH VALLEY PARKWAY
Practice Address - Street 2:1
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3437
Practice Address - Country:US
Practice Address - Phone:972-353-8616
Practice Address - Fax:972-353-5352
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ9128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
88280XOtherBCBS INDIVIDUAL #
752825508OtherTAX ID
TX1274664-06Medicaid
TX1274664-06Medicaid
G15349Medicare UPIN
TX8C2742Medicare PIN