Provider Demographics
NPI:1427481472
Name:KHAN, MUHAMMAD ALI (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:ALI
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 1:700 SW 78TH AVE APT 501
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3373
Mailing Address - Country:US
Mailing Address - Phone:832-359-5178
Mailing Address - Fax:414-805-6851
Practice Address - Street 1:700 SW 78TH AVE APT 501
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3373
Practice Address - Country:US
Practice Address - Phone:832-359-5178
Practice Address - Fax:414-805-6851
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301511430207RH0000X, 207RX0202X
WI65642207RH0003X
FLME156502207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1427481472Medicaid