MEDICARE: HAFIZ KHATTAK 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	208100000X	Physical Medicine & Rehabilitation Physician	2000161127	MO
2	208100000X	Physical Medicine & Rehabilitation Physician	036101887	IL
3	208VP0000X	Pain Medicine Physician	2000161127	MO

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	:	1265419683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAFIZ KHATTAK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2153 DEPT 30703
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35287-9256
Country	:	US
Telephone Number	:	314-961-3038
Fax Number	:	314-961-6731

Provider Business Practice Location Address
First Line	:	7491 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2101
Country	:	US
Telephone Number	:	314-961-3038
Fax Number	:	618-398-6266

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	02/23/2024

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