Healthcare Provider Details

I. General information

NPI: 1730172511
Provider Name (Legal Business Name): MOHAMMED V KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 CAYUGA RD
CHEEKTOWAGA NY
14225-1942
US

IV. Provider business mailing address

132 CAYUGA RD
CHEEKTOWAGA NY
14225-1942
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-9711
  • Fax: 716-204-9717
Mailing address:
  • Phone: 716-204-9711
  • Fax: 716-204-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number206101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: