Healthcare Provider Details

I. General information

NPI: 1215592050
Provider Name (Legal Business Name): AMIR ISHAQ KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16050 EVERWELL LN STE 401A
FRISCO TX
75033-4604
US

IV. Provider business mailing address

16050 EVERWELL LN STE 401A
FRISCO TX
75033-4604
US

V. Phone/Fax

Practice location:
  • Phone: 469-678-8370
  • Fax: 469-678-8371
Mailing address:
  • Phone: 469-678-8370
  • Fax: 469-678-8371

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 State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberW7055
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number70786
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: