Healthcare Provider Details

I. General information

NPI: 1588753420
Provider Name (Legal Business Name): KHALID M KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE UNIVERSITY OF ARIZONA MEDICAL CENTER SUITE 4325F
TUCSON AZ
85724-5066
US

IV. Provider business mailing address

1501 N CAMPBELL AVE UNIVERSITY OF ARIZONA MEDICAL CENTER SUITE 4325F
TUCSON AZ
85724-5066
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-6211
  • Fax: 520-626-9226
Mailing address:
  • Phone: 520-626-6211
  • Fax: 520-626-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number40430
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: