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General NPI Number Information
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NPI Number | 1588218036
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Entity Type | Individual
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Provider Name | ADIL KHAN
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Gender | Male
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 1541 KINGS HWY
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City | SHREVEPORT
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State | LA
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Zip | 71103-4228
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Country | US
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Telephone | 318-626-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 W KIRBY PL
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City | SHREVEPORT
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State | LA
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Zip | 71103-3822
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Country | US
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Telephone | 318-626-0287
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Fax |
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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 | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | 332622
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 332622
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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