Provider Demographics
NPI:1053339416
Name:KHAN, KAMRAN AHMED (MD)
Entity type:Individual
Prefix:
First Name:KAMRAN
Middle Name:AHMED
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 1:2655 W BAKER RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2206
Mailing Address - Country:US
Mailing Address - Phone:281-425-9205
Mailing Address - Fax:
Practice Address - Street 1:2655 W BAKER RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2206
Practice Address - Country:US
Practice Address - Phone:281-425-9205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164683801Medicaid
TX164683802Medicare ID - Type Unspecified
TX8C6302Medicare ID - Type Unspecified
TX164683801Medicaid
TXH47428Medicare UPIN