Healthcare Provider Details

I. General information

NPI: 1043205297
Provider Name (Legal Business Name): ABRAR U KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W THUNDERBIRD BANNER THUNDERBIRD MEDICAL CENTER
GLENDALE AZ
85306
US

IV. Provider business mailing address

5555 W THUNDERBIRD BANNER THUNDERBIRD MEDICAL CENTER
GLENDALE AZ
85306
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-2627
  • Fax: 602-865-2631
Mailing address:
  • Phone: 602-865-2627
  • Fax: 602-865-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number40516
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number40516
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number40516
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01052867
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: