Healthcare Provider Details

I. General information

NPI: 1023211760
Provider Name (Legal Business Name): PERVEZ AHMAD KHAN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 TULANE AVE FL 5
NEW ORLEANS LA
70112-2600
US

IV. Provider business mailing address

131 S ROBERTSON ST STE 1300
NEW ORLEANS LA
70112-2807
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5561
  • Fax: 504-988-1731
Mailing address:
  • Phone: 504-988-5565
  • Fax: 504-988-5793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number321735
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: