MEDICARE: MUJTABA 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	207RC0000X	Cardiovascular Disease Physician	35.072389	OH
2	207UN0901X	Nuclear Cardiology Physician	35.072389	OH
3	207RC0001X	Clinical Cardiac Electrophysiology Physician	35.072389	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	060051912	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629047857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUJTABA A. KHAN MD

Provider Business Mailing Address
First Line	:	7111 N MAIN ST
Second Line	:	STE 50
City	:	DAYTON
State	:	OH
Zip	:	45415-2558
Country	:	US
Telephone Number	:	937-424-5986
Fax Number	:	937-424-5989

Provider Business Practice Location Address
First Line	:	7111 N MAIN ST
Second Line	:	STE 50
City	:	DAYTON
State	:	OH
Zip	:	45415-2558
Country	:	US
Telephone Number	:	937-424-5986
Fax Number	:	937-424-5989

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	09/26/2024

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Directions to “ MUJTABA A. KHAN MD” Practice Location

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