Healthcare Provider Details

I. General information

NPI: 1235795410
Provider Name (Legal Business Name): BILAL M KHAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 NE 19TH DR
OKEECHOBEE FL
34972-1933
US

IV. Provider business mailing address

235 NE 19TH DR
OKEECHOBEE FL
34972-1933
US

V. Phone/Fax

Practice location:
  • Phone: 186-335-7116
  • Fax: 863-357-0424
Mailing address:
  • Phone: 186-335-7116
  • Fax: 863-357-0424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4423
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: