Healthcare Provider Details

I. General information

NPI: 1790993863
Provider Name (Legal Business Name): ADEEL IQBAL KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PATIENTS FIRST DR PULMONARY DIVISION 2ND FLOOR
WASHINGTON MO
63090-4700
US

IV. Provider business mailing address

652 WYNDHAM CROSSINGS CIR
DES PERES MO
63131-2149
US

V. Phone/Fax

Practice location:
  • Phone: 636-231-3695
  • Fax: 636-231-3696
Mailing address:
  • Phone: 716-553-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2011001472
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number54101-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2011001472
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number54101-020
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2011001472
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number54101-020
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number54101-020
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number2011001472
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: