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NPI Code Detail

MEDICARE: FARYAL KHAN MD

MEDICARE: FARYAL 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
1207QA0401XAddiction Medicine (Family Medicine) Physician01091378AIN

General Provider Information

NPI Number : 1811557556
Entity Type Code : Individual
Provider Name (Legal Business Name) : FARYAL KHAN MD
Provider Business Mailing Address
First Line : 3910 LIMA RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-1031
Country : US
Telephone Number : 260-420-6010
Fax Number :
Provider Business Practice Location Address
First Line : 3910 LIMA RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-1031
Country : US
Telephone Number : 260-420-6010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2019
Last Update Date : 12/15/2023

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Directions to “ FARYAL KHAN MD” Practice Location

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