Healthcare Provider Details

I. General information

NPI: 1730836602
Provider Name (Legal Business Name): ADIL KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 KITTY HAWK RD
CONVERSE TX
78109-2808
US

IV. Provider business mailing address

51 RAINEY ST APT 1801
AUSTIN TX
78701-4612
US

V. Phone/Fax

Practice location:
  • Phone: 800-409-7894
  • Fax:
Mailing address:
  • Phone: 800-409-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: