MEDICARE: MAHBOOB ALI 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	207R00000X	Internal Medicine Physician	MD426847	PA
2	207R00000X	Internal Medicine Physician	28163	AL
3	207RN0300X	Nephrology Physician	Q4160	TX
4	208M00000X	Hospitalist Physician	35.095158	OH
5	208M00000X	Hospitalist Physician	MD426847	PA
6	207R00000X	Internal Medicine Physician	Q4160	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00244719	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051541255	OTHER	AL	BLUE CROSS
2	819381	OTHER	PA	FIRST PRIORITY HEALTH
3	051541252	OTHER	AL	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	I38194	OTHER	PA	HEALTHAMERICA
8	1751916	OTHER	PA	HIGHMARK BLUE SHIELD
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	051541253	OTHER	AL	BLUE CROSS
12	7711714	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1508834599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHBOOB ALI KHAN MD

Provider Business Mailing Address
First Line	:	3571 W WHEATLAND RD
Second Line	:	STE 101
City	:	DALLAS
State	:	TX
Zip	:	75237-3461
Country	:	US
Telephone Number	:	972-274-5555
Fax Number	:	972-274-5563

Provider Business Practice Location Address
First Line	:	3571 W WHEATLAND RD
Second Line	:	STE 101
City	:	DALLAS
State	:	TX
Zip	:	75237-3461
Country	:	US
Telephone Number	:	972-274-5555
Fax Number	:	972-274-5563

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	02/07/2023

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Directions to “ MAHBOOB ALI KHAN MD” Practice Location

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