Healthcare Provider Details

I. General information

NPI: 1316044530
Provider Name (Legal Business Name): ATIQUE A KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 W UNIVERSITY DR
DENTON TX
76201
US

IV. Provider business mailing address

PO BOX 2132
COPPELL TX
75019
US

V. Phone/Fax

Practice location:
  • Phone: 940-320-8100
  • Fax:
Mailing address:
  • Phone: 972-258-9570
  • Fax: 972-258-9569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberH7768
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: