Healthcare Provider Details

I. General information

NPI: 1316982309
Provider Name (Legal Business Name): SARFRAZ SAEED KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SARFRAZ SAEED M.D

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N TILLOTSON AVE
MUNCIE IN
47304
US

IV. Provider business mailing address

240 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-1928
  • Fax: 765-741-0310
Mailing address:
  • Phone: 765-288-1928
  • Fax: 765-741-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34865
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01061098A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: