MEDICARE: SHAHIDA A 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	207Q00000X	Family Medicine Physician	35060099	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080060918	OTHER		MEDICARE RAILROAD

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
3	000000016031	OTHER		ANTHEM

General Provider Information

NPI Number	:	1477593523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHIDA A KHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 182255
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43218-2255
Country	:	US
Telephone Number	:	614-430-5730
Fax Number	:

Provider Business Practice Location Address
First Line	:	8490 E NATIONAL RD
Second Line	:
City	:	SOUTH VIENNA
State	:	OH
Zip	:	45369-9707
Country	:	US
Telephone Number	:	937-568-4044
Fax Number	:	937-568-4557

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	10/18/2007

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Directions to “ SHAHIDA A KHAN MD” Practice Location

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