Provider Demographics
NPI:1104142736
Name:KHATTAK, AISHA B (MD)
Entity type:Individual
Prefix:DR
First Name:AISHA
Middle Name:B
Last Name:KHATTAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8002 FM 1464 RD STE 300
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8087
Mailing Address - Country:US
Mailing Address - Phone:832-400-2733
Mailing Address - Fax:832-400-2734
Practice Address - Street 1:8002 FM 1464 RD STE 300
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-8087
Practice Address - Country:US
Practice Address - Phone:832-400-2733
Practice Address - Fax:832-400-2734
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9654207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX364324920Medicaid
TX364324904Medicaid
TX8JH113OtherBCBS