MEDICARE: KANEEZ RUKIA KHAN MD

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	208000000X	Pediatrics Physician	M2670	TX
2	207R00000X	Internal Medicine Physician	M2670	TX

General Provider Information

NPI Number	:	1194826974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANEEZ RUKIA KHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 660599
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0599
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4811 HARRY HINES BLVD STE C
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7711
Country	:	US
Telephone Number	:	214-266-1257
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/25/2022

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