Healthcare Provider Details

I. General information

NPI: 1659631869
Provider Name (Legal Business Name): SHAHRUKH HUSSAIN KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ROSALIND REDFERN GROVER PKWY
MIDLAND TX
79701-5846
US

IV. Provider business mailing address

4214 ANDREWS HWY STE 240
MIDLAND TX
79703-4817
US

V. Phone/Fax

Practice location:
  • Phone: 432-221-1111
  • Fax:
Mailing address:
  • Phone: 432-221-4243
  • Fax: 432-221-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberQ3013
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberQ3013
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberQ3013
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: