Healthcare Provider Details

I. General information

NPI: 1457791113
Provider Name (Legal Business Name): MUHAMMAD OWAIS KHAN M.D. , MBA, FHM.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/07/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S TELSHOR BLVD
LAS CRUCES NM
88011-5069
US

IV. Provider business mailing address

1263 HIDDEN DESERT LN
EL PASO TX
79912-7514
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-5457
  • Fax:
Mailing address:
  • Phone: 630-280-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01075859A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036150828
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: