JALIL A KHAN, MD, PA

Provider Demographics

• NPI: 1255424859
• Name: JALIL A KHAN, MD, PA
• Entity type: Organization
• Organization Name: JALIL A KHAN, MD, PA
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: OWNER
• Authorized Official - First Name: JALIL
• Authorized Official - Middle Name: AZIZ
• Authorized Official - Last Name: KHAN
• Authorized Official - Credentials: M D
• Authorized Official - Phone: 972-353-8616
• Mailing Address - Street 1: 502 NORTH VALLEY PARKWAY
• Mailing Address - Street 2: SUITE 1
• Mailing Address - City: LEWISVILLE
• Mailing Address - State: TX
• Mailing Address - Zip Code: 75067-3437
• Mailing Address - Country: US
• Mailing Address - Phone: 972-353-8616
• Mailing Address - Fax: 972-353-5352
• Practice Address - Street 1: 502 NORTH VALLEY PARKWAY
• Practice Address - Street 2: SUITE 1
• Practice Address - City: LEWISVILLE
• Practice Address - State: TX
• Practice Address - Zip Code: 75067-3437
• Practice Address - Country: US
• Practice Address - Phone: 972-353-8616
• Practice Address - Fax: 972-353-5352
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-10-02
• Last Update Date: 2023-03-07

Provider Licenses

State	License ID	Taxonomies
TX	L2732	207R00000X
TX	L7013	207Q00000X
TX		207Q00000X
TX	J9128	207R00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TX	1451080-07	Medicaid
	066DQ	Other	BCBS GROUP #
TX	1699985-01	Medicaid
TX	1274664-06	Medicaid
TX	1442063-14	Medicaid
TX	1274664-06	Medicaid
TX	1442063-14	Medicaid
	BK4562422	Other	DEA
	BW6337617	Other	DEA
TX	1274664-06	Medicaid
	BW6337617	Other	DEA
	BK4562422	Other	DEA
	G55685	Medicare UPIN
	00326X	Medicare ID - Type Unspecified
	066DQ	Other	BCBS GROUP #
	G15349	Medicare UPIN
	8C2742	Medicare ID - Type Unspecified
TX	1699985-01	Medicaid