Provider Demographics
NPI:1215095559
Name:KHAN, MINA S (MD)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:S
Last Name:KHAN
Suffix:
Gender:F
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:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:AL
Mailing Address - Zip Code:35048-0389
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:101 LEMLEY DR STE A
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2100
Practice Address - Country:US
Practice Address - Phone:205-625-3561
Practice Address - Fax:205-274-9638
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL24841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine