Healthcare Provider Details

I. General information

NPI: 1225006422
Provider Name (Legal Business Name): AZRA KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AZRA SHAHEEN

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W CAMINO REAL SUITE 301
BOCA RATON FL
33433-5510
US

IV. Provider business mailing address

PO BOX 17347
PLANTATION FL
33318-7347
US

V. Phone/Fax

Practice location:
  • Phone: 772-924-2527
  • Fax:
Mailing address:
  • Phone: 954-370-1053
  • Fax: 954-370-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME81344
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: