Healthcare Provider Details

I. General information

NPI: 1841980737
Provider Name (Legal Business Name): MISHA KHALID KHAN MBBS/MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL PARK STE 202
WHEELING WV
26003-6391
US

IV. Provider business mailing address

UNIVERSITY OF TEXAS MEDICAL BRANCH (UTMB), 301 UNIVERSITY BLVD
GALVESTON TX
77555
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-1250
  • Fax: 304-243-1518
Mailing address:
  • Phone: 409-747-5034
  • Fax: 409-747-0721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36660
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: