Healthcare Provider Details

I. General information

NPI: 1487206488
Provider Name (Legal Business Name): SAAD SALEEM KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MOULTON AND PARSONS DR
SAINT JAMES MN
56081-5550
US

IV. Provider business mailing address

1101 MOULTON AND PARSONS DR
SAINT JAMES MN
56081-5550
US

V. Phone/Fax

Practice location:
  • Phone: 507-375-3391
  • Fax:
Mailing address:
  • Phone: 507-375-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351044782
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number71001
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: