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General NPI Number Information
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NPI Number | 1902330988
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Entity Type | Individual
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Provider Name | SABEEN KHAN MD
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Gender | Female
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 1915 LAKE AVE
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City | PLYMOUTH
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State | IN
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Zip | 46563-9366
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Country | US
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Telephone | 574-948-4000
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Fax | 574-948-5454
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Provider Business Mailing Address
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Address Line | 5215 HOLY CROSS PKWY
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City | MISHAWAKA
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State | IN
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Zip | 46545-1469
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Country | US
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Telephone | 574-335-8707
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Fax | 574-335-0741
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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 | 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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01084414A
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License Number State | IN
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