Provider Demographics
NPI:1396713152
Name:KHAN, EMAD A (MD)
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4954
Mailing Address - Country:US
Mailing Address - Phone:816-232-4417
Mailing Address - Fax:816-671-0961
Practice Address - Street 1:2303 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4954
Practice Address - Country:US
Practice Address - Phone:816-232-4417
Practice Address - Fax:816-671-0961
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1172192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204835805Medicaid
KS100288780DMedicaid
MOBK4849280OtherDEA
MOBK4849280OtherDEA
H16350Medicare UPIN