Healthcare Provider Details

I. General information

NPI: 1922482892
Provider Name (Legal Business Name): AHMAD KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 TAVISTOCK LAKES BLVD STE 220
ORLANDO FL
32827-7665
US

IV. Provider business mailing address

9975 TAVISTOCK LAKES BLVD STE 220
ORLANDO FL
32827-7665
US

V. Phone/Fax

Practice location:
  • Phone: 407-932-6193
  • Fax: 407-932-6194
Mailing address:
  • Phone: 407-932-6193
  • Fax: 407-932-6194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28334
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME166380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: