Healthcare Provider Details

I. General information

NPI: 1417210717
Provider Name (Legal Business Name): ADIL ARSHAD KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 UNIVERSITY BLVD S STE 135
JACKSONVILLE FL
32216-4231
US

IV. Provider business mailing address

1824 KING ST SUITE 200
JACKSONVILLE FL
32204
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-8147
  • Fax: 904-400-6674
Mailing address:
  • Phone: 904-384-3343
  • Fax: 904-400-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME141817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: