Provider Demographics
NPI:1851314421
Name:KHAN, SUMBAL KHALID (MD)
Entity Type:Individual
Prefix:
First Name:SUMBAL
Middle Name:KHALID
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUMBAL
Other - Middle Name:
Other - Last Name:KHALID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8911 N CAPITAL OF TEXAS HWY STE 1110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7203
Mailing Address - Country:US
Mailing Address - Phone:877-279-5960
Mailing Address - Fax:877-384-3106
Practice Address - Street 1:8911 N CAPITAL OF TEXAS HWY STE 1110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7203
Practice Address - Country:US
Practice Address - Phone:877-279-5960
Practice Address - Fax:877-384-3106
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5660207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011856OtherMEDICARE GROUP NUMBER
AL1053406280OtherMEDICARE GROUP PAYEE NPI
AL631300102Medicaid
ALOTH000Medicare UPIN