Provider Demographics
NPI:1891765186
Name:KHAN, MOHAMMED SANAULLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:SANAULLAH
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29325 HEALTH CAMPUS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-8201
Mailing Address - Country:US
Mailing Address - Phone:440-414-9400
Mailing Address - Fax:216-201-5591
Practice Address - Street 1:29325 HEALTH CAMPUS DR
Practice Address - Street 2:SUITE 3
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-8201
Practice Address - Country:US
Practice Address - Phone:440-414-9400
Practice Address - Fax:216-201-5591
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110191205OtherRAILROAD MEDICARE
OH0229185Medicaid
OH000000128695OtherANTHEM
OHF69087OtherSUMMA
OH0229185Medicaid
G16697Medicare UPIN