Provider Demographics
NPI:1861557266
Name:KHAN, ABDUL R I (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:R
Last Name:KHAN
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:R
Other - Last Name:KHAN
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1408 TOPPING RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1423
Mailing Address - Country:US
Mailing Address - Phone:314-432-7634
Mailing Address - Fax:314-432-7634
Practice Address - Street 1:1408 TOPPING RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1423
Practice Address - Country:US
Practice Address - Phone:314-432-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine