Individual
MUMTAZ KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
650 JOEL DR, BLANCHFIELD HOSPITAL, FORT CAMPBELL, KY 42223-5318
(270) 798-8388
Mailing address
650 JOEL DR, BLANCHFIELD HOSPITAL, FORT CAMPBELL, KY 42223-5318
(270) 798-8388
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1919
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42873300
—
WI
Enumeration date
01/19/2006
Last updated
10/27/2014
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