Provider Demographics
NPI:1750399077
Name:AHSAN, KHIZAR (MD)
Entity type:Individual
Prefix:
First Name:KHIZAR
Middle Name:
Last Name:AHSAN
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 2880
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0049
Mailing Address - Country:US
Mailing Address - Phone:956-488-9900
Mailing Address - Fax:956-488-9910
Practice Address - Street 1:5342 E HWY 83, C1
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582
Practice Address - Country:US
Practice Address - Phone:956-488-9900
Practice Address - Fax:956-488-9910
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5763174400000X, 207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046218604Medicaid
TX8U0800OtherBCBSTX
TXP00720897OtherRAILROAD MEDICARE
TX8U0800OtherBCBSTX
TX8F0195Medicare PIN
TXP00720897OtherRAILROAD MEDICARE