Provider Demographics
NPI:1538348438
Name:KHAN, MUHAMMAD ALI (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:ALI
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 WYOMING SPGS
Mailing Address - Street 2:BUILDING 2, SUITE 300A
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4312
Mailing Address - Country:US
Mailing Address - Phone:512-388-1190
Mailing Address - Fax:512-388-1174
Practice Address - Street 1:7215 WYOMING SPGS
Practice Address - Street 2:BUILDING 2, SUITE 300A
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4312
Practice Address - Country:US
Practice Address - Phone:512-388-1190
Practice Address - Fax:512-388-1174
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202164207LP2900X
OH57012824207LP2900X
TXP4191207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06306747Medicaid
LA1058912Medicaid
LA4N3837061Medicare PIN
LA4N383Medicare PIN