Basic Information
| Provider Information | |||||||||
| NPI: | 1083807457 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHAHIDA A KHAN MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 182255 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432182255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144305730 | ||||||||
| FaxNumber: | 6144305742 | ||||||||
| Practice Location | |||||||||
| Address1: | 8490 E NATIONAL RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH VIENNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453699707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375684044 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 10/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | SHAHIDA | ||||||||
| AuthorizedOfficialMiddleName: | AZIZ | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9375684044 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.