Provider Demographics
NPI:1730114315
Name:KHAN, HAROON NASIR (MD)
Entity type:Individual
Prefix:
First Name:HAROON
Middle Name:NASIR
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:PO BOX 1906
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37121-1906
Mailing Address - Country:US
Mailing Address - Phone:615-420-5390
Mailing Address - Fax:615-549-1532
Practice Address - Street 1:1419 W BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2513
Practice Address - Country:US
Practice Address - Phone:615-420-5390
Practice Address - Fax:615-549-1532
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19293207RI0200X
TN41277207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPENDINGMedicaid
TN1245266733OtherGROUP NPI
MSBK9777307OtherDEA NUMBER
MSPENDINGMedicare UPIN
MSBK9777307OtherDEA NUMBER