MEDICARE: MOHAMMAD AMJADULLAH 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	2084P0800X	Psychiatry Physician	N8674	TX
2	2084P0800X	Psychiatry Physician	4301093993	MI
3	2084P0804X	Child & Adolescent Psychiatry Physician	N8674	TX
4	2084P0804X	Child & Adolescent Psychiatry Physician	4301093993	MI

General Provider Information

NPI Number	:	1568667251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD AMJADULLAH KHAN M.D.

Provider Business Mailing Address
First Line	:	11673 JOLLYVILLE RD STE 201B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4211
Country	:	US
Telephone Number	:	512-579-0304
Fax Number	:	512-579-0320

Provider Business Practice Location Address
First Line	:	11673 JOLLYVILLE RD STE 201
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4211
Country	:	US
Telephone Number	:	512-579-0304
Fax Number	:	512-579-0320

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	03/31/2026

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