MEDICARE: DANA KHATTAB

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	363A00000X	Physician Assistant		TX

General Provider Information

NPI Number	:	1851112924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA KHATTAB

Provider Business Mailing Address
First Line	:	8513 WELLINGTON POINT DR
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-4273
Country	:	US
Telephone Number	:	972-482-9528
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 S DENTON TAP RD STE 280
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-4073
Country	:	US
Telephone Number	:	972-212-5068
Fax Number	:

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

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	10/22/2024

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Directions to “ DANA KHATTAB ” Practice Location

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