Provider Demographics
NPI:1821265653
Name:KHAN MEDICAL ASSOCIATES SC
Entity Type:Organization
Organization Name:KHAN MEDICAL ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GOUHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-342-9190
Mailing Address - Street 1:1834 W WISCONSIN AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2125
Mailing Address - Country:US
Mailing Address - Phone:414-342-9190
Mailing Address - Fax:414-342-1413
Practice Address - Street 1:1834 W WISCONSIN AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2125
Practice Address - Country:US
Practice Address - Phone:414-342-9190
Practice Address - Fax:414-342-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WII20903174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty