Provider Demographics
NPI:1336149012
Name:KHAN, QAMAR S (MD)
Entity Type:Individual
Prefix:
First Name:QAMAR
Middle Name:S
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 1:1300 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4024
Mailing Address - Country:US
Mailing Address - Phone:407-303-4078
Mailing Address - Fax:407-303-4083
Practice Address - Street 1:1300 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4024
Practice Address - Country:US
Practice Address - Phone:407-303-4078
Practice Address - Fax:407-303-4083
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22515207RH0003X
IL036.092778207RH0003X
FLME99453207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE55079992300Medicaid
NE07312OtherBLUE CROSS BLUE SHIELD
FL265133OtherAVMED
FL32792OtherBCBS
FL001742800Medicaid
P00029878OtherRAILROAD MEDICARE
FL265133OtherAVMED
P00029878OtherRAILROAD MEDICARE
H48643Medicare UPIN