Provider Demographics
NPI:1457349474
Name:KHAN, ABDUL LATEEF (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:LATEEF
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 1:5411 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4074
Mailing Address - Country:US
Mailing Address - Phone:469-870-6020
Mailing Address - Fax:207-345-6221
Practice Address - Street 1:4228 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4600
Practice Address - Country:US
Practice Address - Phone:469-663-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N252OtherBCBS
LA2253429404OtherCDS
ARE 4423OtherSTATE LICENSE
TX1457349474OtherNPI
LA1053554Medicaid
AR157937001Medicaid
LALA 200396OtherSTATE LICENSE
ARBK 9213163OtherDEA
LABK 9331062OtherDEA
AR5N252Medicare ID - Type Unspecified