Provider Demographics
NPI:1972585610
Name:KHAN, TAUSEEF A (MD)
Entity type:Individual
Prefix:
First Name:TAUSEEF
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0583
Mailing Address - Country:US
Mailing Address - Phone:563-589-2557
Mailing Address - Fax:563-589-2665
Practice Address - Street 1:350 N GRANDVIEW AVE
Practice Address - Street 2:SUITE 2145
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6388
Practice Address - Country:US
Practice Address - Phone:563-589-2557
Practice Address - Fax:563-589-2665
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA35360207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1972585610Medicaid
IA1972585610Medicaid
IAI03073Medicare UPIN