Healthcare Provider Details

I. General information

NPI: 1528399078
Provider Name (Legal Business Name): SHAKIL A KHAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6869 5TH AVE S
BIRMINGHAM AL
35212-1866
US

IV. Provider business mailing address

620 BAYHILL RD
BIRMINGHAM AL
35244-3308
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-2031
  • Fax: 205-838-2073
Mailing address:
  • Phone: 205-838-2031
  • Fax: 205-838-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21066
License Number StateAL

VIII. Authorized Official

Name: DR. SHAKIL A KHAN
Title or Position: OWNER/PSYCHIATRIST
Credential: M.D.
Phone: 205-838-2031