MEDICARE: DR. QURATULAIN HASSAN KHAN PH.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	103G00000X	Clinical Neuropsychologist	99055885A	IN
2	103T00000X	Psychologist	99055885A	IN

General Provider Information

NPI Number	:	1295075570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QURATULAIN HASSAN KHAN PH.D.

Provider Business Mailing Address
First Line	:	9531 VALPARAISO CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268
Country	:	US
Telephone Number	:	317-879-8940
Fax Number	:

Provider Business Practice Location Address
First Line	:	9531 VALPARAISO CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268
Country	:	US
Telephone Number	:	317-879-8940
Fax Number	:

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

Provider Enumeration Date	:	02/22/2013
Last Update Date	:	07/20/2016

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