MEDICARE: MOHAMMAD QASIM KHAN M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35090	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104892868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD QASIM KHAN M.D

Provider Business Mailing Address
First Line	:	5434 W CAPITOL DR STE 3
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2298
Country	:	US
Telephone Number	:	414-875-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	5434 W CAPITOL DR STE 3
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2298
Country	:	US
Telephone Number	:	414-875-0505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	12/02/2025

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