Provider Demographics
NPI:1831290923
Name:ALI KHAN, MIR MUJTABA (DO)
Entity Type:Individual
Prefix:DR
First Name:MIR
Middle Name:MUJTABA
Last Name:ALI KHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MUJTABA
Other - Middle Name:
Other - Last Name:ALI-KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:179 INTERSTATE 45 S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4223
Mailing Address - Country:US
Mailing Address - Phone:936-294-0152
Mailing Address - Fax:936-294-9600
Practice Address - Street 1:179 INTERSTATE 45 S
Practice Address - Street 2:SUITE 300
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4223
Practice Address - Country:US
Practice Address - Phone:936-294-0152
Practice Address - Fax:936-294-9600
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine