Basic Information
| Provider Information | |||||||||
| NPI: | 1396804662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | TARIQ | ||||||||
| MiddleName: | ASADULLAH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | AAT SUITE 5300 NEPHROLOGY | ||||||||
| Address2: | 800 STANTON L YOUNG BLVD | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052716842 | ||||||||
| FaxNumber: | 4052716496 | ||||||||
| Practice Location | |||||||||
| Address1: | AAT SUITE 5300 | ||||||||
| Address2: | 800 STANTON L YOUNG BLVD | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052716842 | ||||||||
| FaxNumber: | 4052716496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 01/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0000X | 2004009683 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine |
No ID Information.