Provider Demographics
NPI:1700813342
Name:KHAN, HAMEED M (MD)
Entity Type:Individual
Prefix:DR
First Name:HAMEED
Middle Name:M
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 1:1420 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4438
Mailing Address - Country:US
Mailing Address - Phone:641-450-7000
Mailing Address - Fax:641-450-7001
Practice Address - Street 1:1420 4TH ST SE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4438
Practice Address - Country:US
Practice Address - Phone:641-450-7000
Practice Address - Fax:641-450-7001
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36251207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1700813342OtherBLUE SHIELD
IA0464370Medicaid
IA1700813342Medicaid
IAIB1436030Medicare PIN
IAI22038Medicare UPIN
IAI15611Medicare PIN