Healthcare Provider Details

I. General information

NPI: 1477800571
Provider Name (Legal Business Name): KHAN M.D. 24/7 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E LAKE MEAD PKWY
HENDERSON NV
89015-5575
US

IV. Provider business mailing address

PO BOX 621570
LAS VEGAS NV
89162-1570
US

V. Phone/Fax

Practice location:
  • Phone: 702-616-4602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number8604
License Number StateNV

VIII. Authorized Official

Name: LORI LABRECQUE
Title or Position: ACCTS REP
Credential:
Phone: 702-453-3799