MEDICARE: DR. RIZWAN KHAN 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	207R00000X	Internal Medicine Physician	2484	WV
2	207RN0300X	Nephrology Physician	OS12544	FL

General Provider Information

NPI Number	:	1407169477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RIZWAN KHAN D.O

Provider Business Mailing Address
First Line	:	306 MOHAWK RD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34715-7434
Country	:	US
Telephone Number	:	352-394-1361
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 MOHAWK RD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34715-7434
Country	:	US
Telephone Number	:	352-394-1361
Fax Number	:

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

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	09/17/2014

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