MEDICARE: CAMILA MAYSHA KHAN MD

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	207Q00000X	Family Medicine Physician	2024043442	MO

General Provider Information

NPI Number	:	1134700537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILA MAYSHA KHAN MD

Provider Business Mailing Address
First Line	:	1717 BIDDLE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-3454
Country	:	US
Telephone Number	:	314-814-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 N GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-1621
Country	:	US
Telephone Number	:	314-652-4100
Fax Number	:

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

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	03/11/2026

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