Provider Demographics
NPI:1982631750
Name:KHAN, ASLAM MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ASLAM
Middle Name:MOHAMMAD
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 1:4900 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7500
Mailing Address - Country:US
Mailing Address - Phone:954-735-7550
Mailing Address - Fax:954-735-9130
Practice Address - Street 1:4900 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7500
Practice Address - Country:US
Practice Address - Phone:954-735-7550
Practice Address - Fax:954-735-9130
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38195207RI0011X
OH35047343207RI0011X
CAA36621207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049054700Medicaid
FL93965Medicare ID - Type Unspecified
FLC05252Medicare UPIN