=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033249586
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | Z. A. KHAN, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 11/20/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 N PLANT AVE
-----------------------------------------------------
City | PLANT CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33563-4731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-754-1871
-----------------------------------------------------
Fax | 813-754-1872
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 N PLANT AVE
-----------------------------------------------------
City | PLANT CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33563-4731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-754-1871
-----------------------------------------------------
Fax | 813-754-1872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ZAHEER A KHAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 813-754-1871
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0019906
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------