Provider Demographics
NPI:1699752964
Name:KHAN, HASRAT (MBBS)
Entity type:Individual
Prefix:
First Name:HASRAT
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BROADWAY N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3641
Mailing Address - Country:US
Mailing Address - Phone:701-234-7200
Mailing Address - Fax:701-234-7222
Practice Address - Street 1:801 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-3641
Practice Address - Country:US
Practice Address - Phone:701-234-7200
Practice Address - Fax:701-234-7222
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48156207RC0200X
ND10466207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14186Medicaid
MN027927700Medicaid
MN810000142Medicare ID - Type Unspecified
MN027927700Medicaid
NDP00461203Medicare PIN