Provider Demographics
NPI:1992115653
Name:KHAN, MIR ALI (MD)
Entity type:Individual
Prefix:
First Name:MIR ALI
Middle Name:
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 1:3435 MAIN ST
Mailing Address - Street 2:FARBER HALL, SUITE 252
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-3001
Mailing Address - Country:US
Mailing Address - Phone:716-829-6102
Mailing Address - Fax:716-829-3640
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:FARBER HALL, SUITE 252
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3001
Practice Address - Country:US
Practice Address - Phone:716-829-6102
Practice Address - Fax:716-829-3640
Is Sole Proprietor?:No
Enumeration Date:2014-05-04
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program