MEDICARE: SHAHID I 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	246XC2901X	Cardiovascular Invasive Specialist/Technologist	MD0000028889	TN
2	207RC0000X	Cardiovascular Disease Physician	MD0000028889	TN

General Provider Information

NPI Number	:	1417968314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHID I KHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 2044
Second Line	:	DEPT 4300
City	:	MEMPHIS
State	:	TN
Zip	:	38101-2044
Country	:	US
Telephone Number	:	901-507-6600
Fax Number	:	901-507-6599

Provider Business Practice Location Address
First Line	:	1211 UNION AVE
Second Line	:	STE 495
City	:	MEMPHIS
State	:	TN
Zip	:	38104-6656
Country	:	US
Telephone Number	:	901-507-6600
Fax Number	:	901-507-6599

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	10/21/2024

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