Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1049-25 | WI |
Y | 222Z00000X | Podiatrist | 1049-25 | WI |
N | 213ES0103X | Foot & Ankle Surgery | 1049-25 | WI |
NPI | 1073880936 |
---|---|
Provider Name | Dr. Tahir A Khan |
First Address | Milwaukee, WI 53237-1892 |
Second Address | Milwaukee, WI 53210-2154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2011 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1049-25 | WI LICENSE (01) | WI |