Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 35646 | IA |
N | 207KA0200X | Allergist | 47416 | WI |
NPI | 1134170962 |
---|---|
Provider Name | Hyder Ali Khan |
First Address | Dubuque, IA 52002-2201 |
Second Address | Dubuque, IA 52002-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 12/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0442269 | (05) | IA |
G49014 | (02) |