Provider Demographics
NPI:1265573158
Name:KHAN, IRFAN (MD)
Entity type:Individual
Prefix:
First Name:IRFAN
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9250 GLADES RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3958
Mailing Address - Country:US
Mailing Address - Phone:561-470-1110
Mailing Address - Fax:561-470-1184
Practice Address - Street 1:9250 GLADES RD STE 110
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3958
Practice Address - Country:US
Practice Address - Phone:561-470-1110
Practice Address - Fax:561-470-1184
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1892Medicare PIN
G24227Medicare UPIN