Healthcare Provider Details

I. General information

NPI: 1588154371
Provider Name (Legal Business Name): MALIHA KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 HOLME AVE
PHILADELPHIA PA
19152
US

IV. Provider business mailing address

13738 CHASE ST
CROWN POINT IN
46307-9774
US

V. Phone/Fax

Practice location:
  • Phone: 219-669-0518
  • Fax:
Mailing address:
  • Phone: 219-669-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT216172
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: