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General NPI Number Information
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NPI Number | 1457349474
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Entity Type | Individual
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Provider Name | ABDUL LATEEF KHAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 4228 N JOSEY LN
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City | CARROLLTON
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State | TX
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Zip | 75010-4600
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Country | US
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Telephone | 469-663-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 5411 KINGSTON DR
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City | RICHARDSON
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State | TX
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Zip | 75082-4074
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Country | US
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Telephone | 469-870-6020
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Fax | 207-345-6221
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | S2366
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License Number State | TX
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