MEDICARE: SHARIF UZ ZAMAN KHAN LLC,

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	ME132599	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME132599	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1578056503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARIF UZ ZAMAN KHAN LLC,

Provider Business Mailing Address
First Line	:	320 W FLETCHER AVE STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-3400
Country	:	US
Telephone Number	:	813-679-5276
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 W FLETCHER AVE STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-3400
Country	:	US
Telephone Number	:	813-679-5276
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHARIF UZ ZAMAN KHAN
Credential	:	MD
Telephone Number	:	347-321-3781

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	03/07/2023

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