Healthcare Provider Details

I. General information

NPI: 1912923178
Provider Name (Legal Business Name): AZHAR U KHAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 NW EXPRESSWAY ST STE 650
OKLAHOMA CITY OK
73112-4490
US

IV. Provider business mailing address

3366 NW EXPRESSWAY SUITE 660
OKLAHOMA CITY OK
73112-4462
US

V. Phone/Fax

Practice location:
  • Phone: 405-947-3347
  • Fax: 405-947-4232
Mailing address:
  • Phone: 405-947-3345
  • Fax: 405-946-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number19711
License Number StateOK

VIII. Authorized Official

Name: AZHAR U KHAN
Title or Position: OWNER
Credential: M.D.
Phone: 405-947-3347