MEDICARE: FAZAL AB KHAN M.D.

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	207Q00000X	Family Medicine Physician	036-117596	IL
2	207Q00000X	Family Medicine Physician	N2592	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8BZ702	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1891834685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAZAL AB KHAN M.D.

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PKWY
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5568 WESLAYAN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1942
Country	:	US
Telephone Number	:	713-666-7050
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/01/2025

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