Provider Demographics
NPI:1316990765
Name:KHAN, NAEEM ULLAH (MD)
Entity type:Individual
Prefix:
First Name:NAEEM
Middle Name:ULLAH
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 1:1915 S COULTER ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1780
Mailing Address - Country:US
Mailing Address - Phone:806-352-5400
Mailing Address - Fax:805-352-8555
Practice Address - Street 1:1915 COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-352-5400
Practice Address - Fax:806-352-8555
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162675609Medicaid
TX8F6190Medicare PIN
H34903Medicare UPIN