Healthcare Provider Details

I. General information

NPI: 1588811087
Provider Name (Legal Business Name): INTERNATIONAL FAMILY MEDICINE AND WALK-IN CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3806 W 86TH ST
INDIANAPOLIS IN
46268-1905
US

IV. Provider business mailing address

3806 W 86TH ST
INDIANAPOLIS IN
46268-1905
US

V. Phone/Fax

Practice location:
  • Phone: 317-731-5887
  • Fax: 317-731-5892
Mailing address:
  • Phone: 317-731-5887
  • Fax: 317-731-5892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50005032A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number50005032A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number50005032A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number50005032A
License Number StateIN

VIII. Authorized Official

Name: DR. SHAUKAT ALI KHAN
Title or Position: OWNER
Credential: M.D.
Phone: 317-731-5887