Provider Demographics
NPI:1851475669
Name:KHAN, KHALID (MD)
Entity Type:Individual
Prefix:MR
First Name:KHALID
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHALID
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:#62 DOCTORS PARK
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-0718
Mailing Address - Country:US
Mailing Address - Phone:573-335-5359
Mailing Address - Fax:573-335-2790
Practice Address - Street 1:#62 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63702-0718
Practice Address - Country:US
Practice Address - Phone:573-335-5359
Practice Address - Fax:573-335-2790
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1D24207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO107152OtherHEALTHLINK
MO13262OtherBLUE CROSS BLUE SHIELD
MO13262OtherBLUE CROSS BLUE SHIELD