Provider Demographics
NPI:1215904453
Name:KHAN, SIKANDAR (MD)
Entity type:Individual
Prefix:MR
First Name:SIKANDAR
Middle Name:
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 1:137 HOSPITAL DR.
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5063
Mailing Address - Country:US
Mailing Address - Phone:850-833-7400
Mailing Address - Fax:850-833-7528
Practice Address - Street 1:137 HOSPITAL DR.
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5063
Practice Address - Country:US
Practice Address - Phone:850-833-7400
Practice Address - Fax:850-833-7528
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 691082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
177175OtherVALUE OPTIONS
FL78782OtherBLUE CROSS BLUE SHIELD
71732OtherCIGNA
FL266962500Medicaid
FL78782ZMedicare ID - Type Unspecified
FL266962500Medicaid