MEDICARE: DR. KHURRAM SHAHZAD AWAN D.O

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	259875	NY

General Provider Information

NPI Number	:	1275837080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHURRAM SHAHZAD AWAN D.O

Provider Business Mailing Address
First Line	:	15801 WILLETS POINT BLVD.
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-3934
Country	:	US
Telephone Number	:	718-767-3055
Fax Number	:

Provider Business Practice Location Address
First Line	:	2552 STEINWAY ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-3777
Country	:	US
Telephone Number	:	718-777-6695
Fax Number	:

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

Provider Enumeration Date	:	01/08/2011
Last Update Date	:	01/25/2012

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