MEDICARE: KHALID A 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	207L00000X	Anesthesiology Physician	19113	OK
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	19113	OK
3	208VP0000X	Pain Medicine Physician	19113	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00474293	OTHER	OK	MEDICARE RR

General Provider Information

NPI Number	:	1306814777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHALID A KHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 14459
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73113-0459
Country	:	US
Telephone Number	:	405-775-9350
Fax Number	:	405-775-9360

Provider Business Practice Location Address
First Line	:	3200 MEDICAL PARK DR
Second Line	:
City	:	SHAWNEE
State	:	OK
Zip	:	74804-5014
Country	:	US
Telephone Number	:	405-878-9490
Fax Number	:	405-878-9492

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	03/14/2014

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