Provider Demographics
NPI:1508852294
Name:KHAN, IRINA S (MD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:S
Last Name:KHAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 ESKENAZI AVE
Mailing Address - Street 2:5/3 FACULTY BLDG, DEP OF MEDICINE, SUIT E2121
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5166
Mailing Address - Country:US
Mailing Address - Phone:317-880-8211
Mailing Address - Fax:317-880-0565
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:5/3 FACULTY BLDG, DEP OF MEDICINE, SUIT E2121
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5166
Practice Address - Country:US
Practice Address - Phone:317-880-8211
Practice Address - Fax:317-880-0565
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400033493OtherMEDICARE PTIN
IN200832460Medicaid