Provider Demographics
NPI:1811054539
Name:KHAN, IMRAN A (MD)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:A
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 1:4746 ROWAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-5601
Mailing Address - Country:US
Mailing Address - Phone:727-375-7788
Mailing Address - Fax:727-375-7772
Practice Address - Street 1:4746 ROWAN RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-5601
Practice Address - Country:US
Practice Address - Phone:727-375-7788
Practice Address - Fax:727-375-7772
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106316207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0091114OtherBLUE CROSS OF MI
MI01006479OtherHEALTH PLUS OF MI
MI104957790Medicaid
MI01006479OtherHEALTH PLUS OF MI
I69534Medicare UPIN