=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376528406
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KHAN ADNAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2005
-----------------------------------------------------
Last Update Date | 06/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1020 LAKEVIEW RD
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33756-3423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-461-1439
-----------------------------------------------------
Fax | 727-443-7230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10549
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33733-0549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-824-8100
-----------------------------------------------------
Fax | 727-824-8166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME71902
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------