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General NPI Number Information
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NPI Number | 1992183636
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Entity Type | Individual
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Provider Name | ABRAHAM KHAN
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Gender | Male
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 15303 AMBERLY DR STE A
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City | TAMPA
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State | FL
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Zip | 33647
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Country | US
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Telephone | 813-574-2460
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Fax |
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Provider Business Mailing Address
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Address Line | 1868 HIGHLAND OAKS BLVD STE B
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City | LUTZ
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State | FL
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Zip | 33559-7413
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Country | US
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Telephone | 813-574-2460
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Fax | 813-949-5001
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME135964
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License Number State | FL
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