Basic Information
| Provider Information | |||||||||
| NPI: | 1902123995 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | ABDUL | ||||||||
| MiddleName: | MANNAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 CHATEAU MOUTON DR | ||||||||
| Address2: | |||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700651902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2517164428 | ||||||||
| FaxNumber: | 5044676999 | ||||||||
| Practice Location | |||||||||
| Address1: | 15813 PAUL VEGA MD DR STE 300A | ||||||||
| Address2: | |||||||||
| City: | HAMMOND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704031431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9852307195 | ||||||||
| FaxNumber: | 9852307196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MD.205106 | LA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RE0101X | MD.205106 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.