MEDICARE: KHAN MEDICAL ASSOCIATES SC

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	174400000X	Specialist	I20903	WI

General Provider Information

NPI Number	:	1821265653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHAN MEDICAL ASSOCIATES SC

Provider Business Mailing Address
First Line	:	1834 W WISCONSIN AVE
Second Line	:	SECOND FLOOR
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2125
Country	:	US
Telephone Number	:	414-342-9190
Fax Number	:	414-342-1413

Provider Business Practice Location Address
First Line	:	1834 W WISCONSIN AVE
Second Line	:	SECOND FLOOR
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2125
Country	:	US
Telephone Number	:	414-342-9190
Fax Number	:	414-342-1413

Authorized Official
Title or Position	:	OWNER
Name	:	GOUHAR KHAN
Credential	:	MD
Telephone Number	:	414-342-9190

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	05/12/2008

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Directions to “KHAN MEDICAL ASSOCIATES SC ” Practice Location

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