Provider Demographics
NPI:1295764629
Name:KHAN, MATHEEN K (MD)
Entity type:Individual
Prefix:DR
First Name:MATHEEN
Middle Name:K
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8121 NATIONAL AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7530
Mailing Address - Country:US
Mailing Address - Phone:405-732-6223
Mailing Address - Fax:405-741-0414
Practice Address - Street 1:8121 NATIONAL AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7530
Practice Address - Country:US
Practice Address - Phone:405-732-6223
Practice Address - Fax:405-741-0414
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13271207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1295764629OtherBLUE CROSS BLUE SHIELD
OK1295764629Medicaid
OK1295764629Medicaid
OK1295764629Medicare PIN