Provider Demographics
NPI:1275689473
Name:KHAN, ZAKIR HASAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ZAKIR
Middle Name:HASAN
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 1:2406 S SEACREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6702
Mailing Address - Country:US
Mailing Address - Phone:561-734-0776
Mailing Address - Fax:561-734-2285
Practice Address - Street 1:2406 S SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6702
Practice Address - Country:US
Practice Address - Phone:561-734-0776
Practice Address - Fax:561-734-2285
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME4009207R00000X
FL40098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63117Medicare UPIN