Provider Demographics
NPI:1699468645
Name:KHAN, AMATUL AZIZ (MD)
Entity type:Individual
Prefix:
First Name:AMATUL
Middle Name:AZIZ
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5731 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5056
Mailing Address - Country:US
Mailing Address - Phone:941-290-2137
Mailing Address - Fax:
Practice Address - Street 1:1808 N 32ND ST APT 109
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-3861
Practice Address - Country:US
Practice Address - Phone:602-772-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program