Provider Demographics
NPI:1285089672
Name:KHAN, MOHAMMAD (DO)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MOHAMMAD
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:ONSPOT DERMATOLOGY
Mailing Address - Street 2:1131 SOUTH ORANGE AVENUE, ORLANDO FL 33806
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4709
Mailing Address - Country:US
Mailing Address - Phone:480-659-8226
Mailing Address - Fax:
Practice Address - Street 1:1131 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1226
Practice Address - Country:US
Practice Address - Phone:941-444-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS21641207ZD0900X
CA390200000X
AZ009736207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program