Healthcare Provider Details

I. General information

NPI: 1477996775
Provider Name (Legal Business Name): ASMA KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SKYLINE BLVD
CLOQUET MN
55720-3787
US

IV. Provider business mailing address

12430 OXFORD PARK DR APT 7310
HOUSTON TX
77082-2563
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-4641
  • Fax:
Mailing address:
  • Phone: 832-955-5177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number303663
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number72877
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: