Provider Demographics
NPI:1396700043
Name:KHAN, MUHAMMAD ALI (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:ALI
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:PO BOX 737045
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-7045
Mailing Address - Country:US
Mailing Address - Phone:469-453-8118
Mailing Address - Fax:630-596-1220
Practice Address - Street 1:12505 LEBANON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-8298
Practice Address - Country:US
Practice Address - Phone:469-453-8118
Practice Address - Fax:630-596-1220
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2594207RI0200X, 207RI0200X
MN40289207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281443602Medicaid
MN822920100Medicaid
TX281443602Medicaid
TXTXB123849Medicare PIN
TXTXB146889Medicare PIN
TX281443602Medicaid
MN822920100Medicaid