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General NPI Number Information
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NPI Number | 1114965084
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Entity Type | Individual
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Provider Name | FARZANA A KHAN MD
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Gender | Female
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 2010 E COLUMBUS DR
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City | EAST CHICAGO
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State | IN
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Zip | 46312
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Country | US
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Telephone | 219-397-6369
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Fax |
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Provider Business Mailing Address
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Address Line | 2010 E COLUMBUS DR
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City | EAST CHICAGO
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State | IN
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Zip | 46312-2830
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Country | US
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Telephone | 219-397-6369
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Fax | 219-750-9699
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01038685
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License Number State | IN
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