Healthcare Provider Details

I. General information

NPI: 1265444715
Provider Name (Legal Business Name): ASJAD U KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22655 BAYSHORE RD STE 110
PORT CHARLOTTE FL
33980-2005
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 941-235-4900
  • Fax: 941-235-4901
Mailing address:
  • Phone: 239-343-9890
  • Fax: 239-343-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME99779
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number222881
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME99779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: