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NPI Code Detail

MEDICARE: DR. MIRZA SAMIUDDIN KHAN M.D.

MEDICARE: DR. MIRZA SAMIUDDIN 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
1208M00000XHospitalist Physician57776TN
2207R00000XInternal Medicine Physician2022010401MO

General Provider Information

NPI Number : 1922488808
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MIRZA SAMIUDDIN KHAN M.D.
Provider Business Mailing Address
First Line : 3841 GREEN HILLS VILLAGE DR STE 200
Second Line :
City : NASHVILLE
State : TN
Zip : 37215-2691
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4401 WORNALL RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-3241
Country : US
Telephone Number : 816-932-5475
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2015
Last Update Date : 07/25/2022

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