Healthcare Provider Details

I. General information

NPI: 1861674251
Provider Name (Legal Business Name): SHUJATH ALI KHAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8121 NATIONAL AVE SUITE 401
MIDWEST CITY OK
73110-7530
US

IV. Provider business mailing address

8121 NATIONAL AVE SUITE 401
MIDWEST CITY OK
73110-7530
US

V. Phone/Fax

Practice location:
  • Phone: 405-732-6223
  • Fax:
Mailing address:
  • Phone: 405-732-6223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN WALLS
Title or Position: OFFICE MANAGER
Credential:
Phone: 405-732-6223