Provider Demographics
NPI:1891982278
Name:KHAN, MOHAMMED I (MD)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMED
Middle Name:I
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 1:149 E SH 121
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019
Mailing Address - Country:US
Mailing Address - Phone:972-833-7246
Mailing Address - Fax:972-833-7256
Practice Address - Street 1:149 E STATE HIGHWAY 121
Practice Address - Street 2:SUITE 105
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:806-441-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0883208VP0014X, 208VP0014X, 208VP0014X
TXMT196139208100000X
WAMD60364689208VP0000X
ARE9378208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR220969001Medicaid