Healthcare Provider Details

I. General information

NPI: 1861577694
Provider Name (Legal Business Name): JAMIL H KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 SUNRISE PLAZA DR SUITE ONE
CLERMONT FL
34714-6205
US

IV. Provider business mailing address

1528 SUNRISE PLAZA DR SUITE ONE
CLERMONT FL
34714-6205
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-7728
  • Fax: 352-394-6369
Mailing address:
  • Phone: 352-394-7728
  • Fax: 352-394-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME76198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: