Provider Demographics
NPI:1215052121
Name:KHAN, ALI RAZA (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:RAZA
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST STE 1101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2740
Mailing Address - Country:US
Mailing Address - Phone:713-363-8592
Mailing Address - Fax:713-790-3013
Practice Address - Street 1:6550 FANNIN ST STE 1101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2740
Practice Address - Country:US
Practice Address - Phone:713-363-8592
Practice Address - Fax:713-790-3013
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01085018A207R00000X
IL036.128358207RN0300X
TXU4239207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-128358Medicaid