Provider Demographics
NPI:1255538302
Name:KHAN, AAYESHA MUMTAZ (MD)
Entity type:Individual
Prefix:DR
First Name:AAYESHA
Middle Name:MUMTAZ
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 VILLAGE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5510
Mailing Address - Country:US
Mailing Address - Phone:210-957-1115
Mailing Address - Fax:877-669-1739
Practice Address - Street 1:8500 VILLAGE DR STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5510
Practice Address - Country:US
Practice Address - Phone:210-957-1115
Practice Address - Fax:877-669-1739
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2701174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308802301Medicaid
TXTXB153556Medicare PIN