Healthcare Provider Details

I. General information

NPI: 1659374866
Provider Name (Legal Business Name): MOHAMMAD BABAR KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3195 S PRICE RD STE 150
CHANDLER AZ
85248
US

IV. Provider business mailing address

1900 W CHANDLER BLVD PO BOX 15-336
CHANDLER AZ
85224-8632
US

V. Phone/Fax

Practice location:
  • Phone: 480-678-0796
  • Fax: 480-722-0240
Mailing address:
  • Phone: 480-722-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberD59788
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: