Provider Demographics
NPI:1962591313
Name:KHAN, SHAHBAZ M (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHBAZ
Middle Name:M
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4240 BLUE RIDGE BLVD
Mailing Address - Street 2:STE 301
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-1705
Mailing Address - Country:US
Mailing Address - Phone:816-291-4700
Mailing Address - Fax:816-291-4600
Practice Address - Street 1:4240 BLUE RIDGE BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133
Practice Address - Country:US
Practice Address - Phone:816-291-4700
Practice Address - Fax:816-291-4600
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20001457872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205715105Medicaid
KS200307930AMedicaid
MO205715105Medicaid