Provider Demographics
NPI:1881856532
Name:KHAN, UMAR (MD)
Entity type:Individual
Prefix:DR
First Name:UMAR
Middle Name:
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 1:440 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1707
Mailing Address - Country:US
Mailing Address - Phone:270-901-1991
Mailing Address - Fax:270-282-7109
Practice Address - Street 1:440 HIGH ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1707
Practice Address - Country:US
Practice Address - Phone:270-901-1991
Practice Address - Fax:270-282-7109
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2015-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44844207RS0010X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100198800Medicaid
KYK050260Medicare PIN