MEDICARE: DR. ABDUL S 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	ME0083644	FL

General Provider Information

NPI Number	:	1710902564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABDUL S KHAN MD

Provider Business Mailing Address
First Line	:	2707 E GRAND RESERVE
Second Line	:	#1422
City	:	CLEARWATER
State	:	FL
Zip	:	33759-6216
Country	:	US
Telephone Number	:	727-447-5454
Fax Number	:	727-441-4782

Provider Business Practice Location Address
First Line	:	2707 E GRAND RESERVE CIR
Second Line	:	APT 1422
City	:	CLEARWATER
State	:	FL
Zip	:	33759-4908
Country	:	US
Telephone Number	:	727-447-5454
Fax Number	:	727-441-4782

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	06/10/2008

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