Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | P0988 | TX |
Y | 2080P0202X | Pediatric Cardiologist | 01080613A | IN |
NPI | 1134401896 |
---|---|
Provider Name | Abdul Hamid Khan |
First Address | Fort Wayne, IN 46804-7934 |
Second Address | Fort Wayne, IN 46804-4140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2011 |
Last Update Date | 14/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
186873901 | (05) | TX |
300017482 | (05) | IN |