MEDICARE: TARIQ ASADULLAH KHAN M.D.

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	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	2004009683	MO
2	207RN0300X	Nephrology Physician	33459	OK

General Provider Information

NPI Number	:	1396804662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARIQ ASADULLAH KHAN M.D.

Provider Business Mailing Address
First Line	:	4221 S WESTERN AVE STE 5020
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3445
Country	:	US
Telephone Number	:	405-768-5904
Fax Number	:

Provider Business Practice Location Address
First Line	:	4221 S WESTERN AVE STE 5020
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3445
Country	:	US
Telephone Number	:	405-768-5904
Fax Number	:

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	05/01/2024

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