Healthcare Provider Details

I. General information

NPI: 1891037446
Provider Name (Legal Business Name): FATIMA E KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 MADACA LN
TAMPA FL
33618-2048
US

IV. Provider business mailing address

3645 MADACA LN
TAMPA FL
33618-2048
US

V. Phone/Fax

Practice location:
  • Phone: 813-969-0116
  • Fax: 813-969-3794
Mailing address:
  • Phone: 813-969-0116
  • Fax: 813-969-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME142379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: