Healthcare Provider Details

I. General information

NPI: 1104372200
Provider Name (Legal Business Name): SHER ALI KHAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-5759
US

IV. Provider business mailing address

3224 S ESPANA CIR
AURORA CO
80013-3729
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1443
  • Fax:
Mailing address:
  • Phone: 773-807-6871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2020-0468
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberMD2022-1359
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.067977
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: