MEDICARE: KHALID M 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	2080P0206X	Pediatric Gastroenterology Physician	40430	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1344716	OTHER		ARAZ

General Provider Information

NPI Number	:	1588753420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHALID M KHAN MD

Provider Business Mailing Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:	UNIVERSITY OF ARIZONA MEDICAL CENTER SUITE 4325F
City	:	TUCSON
State	:	AZ
Zip	:	85724-5066
Country	:	US
Telephone Number	:	520-626-6211
Fax Number	:	520-626-9226

Provider Business Practice Location Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:	UNIVERSITY OF ARIZONA MEDICAL CENTER SUITE 4325F
City	:	TUCSON
State	:	AZ
Zip	:	85724-5066
Country	:	US
Telephone Number	:	520-626-6211
Fax Number	:	520-626-9226

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	04/23/2012

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