MEDICARE: HABIB KHAN MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME-97166	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME-97166	OTHER	FL	LICENSE NUMBER

General Provider Information

NPI Number	:	1013276922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HABIB KHAN MD PA

Provider Business Mailing Address
First Line	:	8131 WOODSMUIR DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-1646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8131 WOODSMUIR DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-1646
Country	:	US
Telephone Number	:	786-487-1395
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	WAQAS HUSSAIN
Credential	:
Telephone Number	:	405-563-2443

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	05/18/2012

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