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General NPI Number Information
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NPI Number | 1467754192
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Entity Type | Organization
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Legal Business Name | HUMAIRA KHAN MD PA
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 4850 W OAKLAND PARK BLVD #132
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-7260
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Country | US
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Telephone | 954-486-8663
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Fax | 954-486-8979
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Provider Business Mailing Address
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Address Line | PO BOX 100488
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City | FT LAUDERDALE
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State | FL
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Zip | 33310-0488
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Country | US
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Telephone | 954-486-8663
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Fax | 954-486-8979
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Authorized Official
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Title or Position | OWNER
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Name | HUMAIRA V KHAN
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Credential | MD
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Telephone | 954-486-8663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME81096
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License Number State | FL
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