Healthcare Provider Details

I. General information

NPI: 1871087767
Provider Name (Legal Business Name): SADIAH N KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGHWAY 2 W
DEVILS LAKE ND
58301-3532
US

IV. Provider business mailing address

200 HIGHWAY 2 W
DEVILS LAKE ND
58301-3532
US

V. Phone/Fax

Practice location:
  • Phone: 701-665-2200
  • Fax:
Mailing address:
  • Phone: 701-665-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number69178
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number19779
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: