Provider Demographics
NPI:1861835787
Name:ATIQUE A. KHAN M.D.P.A.
Entity Type:Organization
Organization Name:ATIQUE A. KHAN M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATIQUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-488-5308
Mailing Address - Street 1:1023 SUMMERPLACE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5121
Mailing Address - Country:US
Mailing Address - Phone:817-488-5308
Mailing Address - Fax:817-488-7149
Practice Address - Street 1:2026 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-0644
Practice Address - Country:US
Practice Address - Phone:817-488-5308
Practice Address - Fax:817-488-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH77682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114789402Medicaid
TX277130Medicare PIN
TX114789402Medicaid