Provider Demographics
NPI:1932148434
Name:KHAN, SHAKIL AHMED (MD)
Entity Type:Individual
Prefix:
First Name:SHAKIL
Middle Name:AHMED
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 1:620 BAYHILL RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3308
Mailing Address - Country:US
Mailing Address - Phone:205-838-2031
Mailing Address - Fax:205-838-2073
Practice Address - Street 1:6869 5TH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35212-1866
Practice Address - Country:US
Practice Address - Phone:205-838-2031
Practice Address - Fax:205-838-2073
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL210662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000079003Medicaid
AL000079003Medicaid
G57072Medicare UPIN