Healthcare Provider Details

I. General information

NPI: 1659518264
Provider Name (Legal Business Name): ASMA N KHAN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 E BAY DR STE 106
CLEARWATER FL
33764-6866
US

IV. Provider business mailing address

4625 E BAY DR
CLEARWATER FL
33764-5738
US

V. Phone/Fax

Practice location:
  • Phone: 737-550-8401
  • Fax: 904-224-2002
Mailing address:
  • Phone: 727-434-4468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006030
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: