Provider Demographics
NPI:1285896662
Name:KHAN, RINTU INTEKHAB (MD)
Entity type:Individual
Prefix:DR
First Name:RINTU
Middle Name:INTEKHAB
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3505 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-387-2300
Mailing Address - Fax:816-387-2715
Practice Address - Street 1:3505 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-387-2300
Practice Address - Fax:816-387-2715
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD1025452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206761900Medicaid
MOF75731Medicare UPIN
MO8091363Medicare PIN