Basic Information
| Provider Information | |||||||||
| NPI: | 1508834599 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | MAHBOOB | ||||||||
| MiddleName: | ALI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3571 W WHEATLAND RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752373461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722745555 | ||||||||
| FaxNumber: | 9722745563 | ||||||||
| Practice Location | |||||||||
| Address1: | 3571 W WHEATLAND RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752373461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722745555 | ||||||||
| FaxNumber: | 9722745563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 01/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD426847 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 28163 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 35.095158 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | MD426847 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RN0300X | Q4160 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 009910049 | 05 | AL | MEDICAID | 101349604 | 05 | PA | MEDICAID | I38194 | 01 | PA | HEALTHAMERICA | OTHER | 051541255 | 01 | AL | BLUE CROSS | OTHER | 819381 | 01 | PA | FIRST PRIORITY HEALTH | OTHER | P00244719 | 01 | PA | RAILROAD MEDICARE | OTHER | 009910050 | 05 | AL | MEDICAID | 7711714 | 01 | PA | AETNA | OTHER | 051541252 | 01 | AL | BLUE CROSS | OTHER | 1751916 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 009910051 | 05 | AL | MEDICAID | 051541253 | 01 | AL | BLUE CROSS | OTHER |