Healthcare Provider Details

I. General information

NPI: 1336149012
Provider Name (Legal Business Name): QAMAR S KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W OAK ST
KISSIMMEE FL
34741-4024
US

IV. Provider business mailing address

1300 W OAK ST
KISSIMMEE FL
34741-4024
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4078
  • Fax: 407-303-4083
Mailing address:
  • Phone: 407-303-4078
  • Fax: 407-303-4083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number22515
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036.092778
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME99453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: