Healthcare Provider Details

I. General information

NPI: 1447993142
Provider Name (Legal Business Name): MAAZULLAH KHAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MCAULEY CT STE B
HOT SPRINGS AR
71913-6344
US

IV. Provider business mailing address

PO BOX 1848
MENA AR
71953-1841
US

V. Phone/Fax

Practice location:
  • Phone: 888-710-8220
  • Fax: 866-573-0761
Mailing address:
  • Phone: 888-710-8220
  • Fax: 866-573-0761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number310
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: