Provider Demographics
NPI:1427010685
Name:KHAN, MOHAMMAD YOUSAF (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:YOUSAF
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:L
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 122579 DEPT 2579
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2579
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:2770 3RD AVE STE 210
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-0404
Practice Address - Country:US
Practice Address - Phone:337-494-6768
Practice Address - Fax:337-494-6792
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.14445R207RH0003X, 207R00000X, 207RH0003X
TXM5283207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1141143Medicaid
TX8W5625OtherBCBS
LA2154168Medicaid
TX01042054OtherAMERIGROUP
LA1141143Medicaid
LAM5283OtherSTATE LICENSE
TXP00365833OtherRAIL ROAD MEDICARE
LAP00922480OtherRAILROAD MEDICARE
LA2154168Medicaid
TXP00365833OtherRAIL ROAD MEDICARE