Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CPO02454 | MD |
Y | 222Z00000X | Podiatrist | CPO02454 | MD |
N | 224P00000X | Prosthetist | CPO02454 | MD |
NPI | 1235679366 |
---|---|
Provider Name | Fahim Uzzaman Khan |
First Address | La Crosse, WI 54601-8505 |
Second Address | La Crosse, WI 54601-5467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2017 |
Last Update Date | 08/03/2017 |