Provider Demographics
NPI:1922363175
Name:KHAN, ASMA SHAHID (MD)
Entity type:Individual
Prefix:DR
First Name:ASMA
Middle Name:SHAHID
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ASMA
Other - Middle Name:
Other - Last Name:SHAHID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:149 E SH 121
Mailing Address - Street 2:STE 105
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019
Mailing Address - Country:US
Mailing Address - Phone:972-833-7246
Mailing Address - Fax:972-833-7256
Practice Address - Street 1:149 E SH 121
Practice Address - Street 2:STE 105
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:972-833-7246
Practice Address - Fax:972-833-7256
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9276207Q00000X
TXR3887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR426842YX6XMedicare PIN