Healthcare Provider Details

I. General information

NPI: 1790710648
Provider Name (Legal Business Name): ATAUR-REHMAN RIZWAN KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21212 NORTHWEST FRWY. STE 555 NORTHWEST CARDIOLOGY CONSULTANTS, P.A.
CYPRESS TX
77429
US

IV. Provider business mailing address

21212 NORTHWEST FRWY. STE 555 NORTHWEST CARDIOLOGY CONSULTANTS, P.A.
CYPRESS TX
77429
US

V. Phone/Fax

Practice location:
  • Phone: 281-955-0786
  • Fax: 281-955-8848
Mailing address:
  • Phone: 281-955-0786
  • Fax: 281-955-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL6461
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberL6461
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: