Healthcare Provider Details

I. General information

NPI: 1245469287
Provider Name (Legal Business Name): ZEESHAN KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 S WESTERN AVE STE 2010
OKLAHOMA CITY OK
73109-3445
US

IV. Provider business mailing address

5401 N PORTLAND AVE STE 410
OKLAHOMA CITY OK
73112-2131
US

V. Phone/Fax

Practice location:
  • Phone: 54-644-5120
  • Fax: 405-644-5309
Mailing address:
  • Phone: 405-271-5963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27098
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number27098
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number27098
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: