Provider Demographics
NPI:1538168810
Name:KHAN, KHALID LATIF (MD)
Entity type:Individual
Prefix:MR
First Name:KHALID
Middle Name:LATIF
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:216 BATTLE ST E
Mailing Address - Street 2:STE A
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2420
Mailing Address - Country:US
Mailing Address - Phone:256-362-1590
Mailing Address - Fax:256-362-1540
Practice Address - Street 1:216 BATTLE ST E
Practice Address - Street 2:STE A
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2420
Practice Address - Country:US
Practice Address - Phone:256-362-1590
Practice Address - Fax:256-362-1540
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2010-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL00006890207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000043391Medicaid
AL510-43391OtherBCBS
AL000043391Medicaid
AL510-43391OtherBCBS