Healthcare Provider Details

I. General information

NPI: 1386879013
Provider Name (Legal Business Name): DURRESHAHWAR KHURSHEED KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 SETON CENTER PKWY
AUSTIN TX
78759-5290
US

IV. Provider business mailing address

3900 AVERY WOODS LN
CEDAR PARK TX
78613-7673
US

V. Phone/Fax

Practice location:
  • Phone: 512-338-8388
  • Fax:
Mailing address:
  • Phone: 404-759-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ8922
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: