MEDICARE: DR. MOHAMMAD FARRUKH 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	208600000X	Surgery Physician	MD029897	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30021732	OTHER	PA	KEYSTONE MERCY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7542074	OTHER	PA	AETNA HMO
4	01884714	OTHER	PA	BLUE SHIELD
5	2357937000	OTHER	PA	KEYSTONE HEALTH PLAN EAST
6	1064610	OTHER	PA	AETNA PPO

General Provider Information

NPI Number	:	1730179276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD FARRUKH KHAN MD

Provider Business Mailing Address
First Line	:	1600 PERRINEVILLE RD STE 2-303
Second Line	:
City	:	MONROE TOWNSHIP
State	:	NJ
Zip	:	08831-4923
Country	:	US
Telephone Number	:	216-273-9800
Fax Number	:	216-273-9998

Provider Business Practice Location Address
First Line	:	1585 3RD ST
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-5102
Country	:	US
Telephone Number	:	337-653-2373
Fax Number	:

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	08/11/2022

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