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General NPI Number Information
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NPI Number | 1831251446
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Entity Type | Individual
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Provider Name | HASIBUL HASSAN KHAN MD
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 213 S PINE AVE
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City | INVERNESS
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State | FL
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Zip | 34452-4830
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Country | US
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Telephone | 352-560-3000
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Fax | 352-419-6513
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Provider Business Mailing Address
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Address Line | 3404 N LECANTO HWY SUITE C
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City | BEVERLY HILLS
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State | FL
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Zip | 34465-4830
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Country | US
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Telephone | 352-746-0600
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Fax | 352-746-3838
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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 | ME100419
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License Number State | FL
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