Individual
MARYAM IDREES KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1600 N GRAND AVE STE 430, PUEBLO, CO 81003-2760
(719) 545-8240
(719) 545-4319
Mailing address
1600 N GRAND AVE STE 430, PUEBLO, CO 81003-2760
(719) 545-8240
(719) 545-4319
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
322450
NY
208600000X
Surgery Physician
Primary
DR.0073816
CO
2086X0206X
Surgical Oncology Physician
322450
NY
2086X0206X
Surgical Oncology Physician
DR.0073816
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/03/2018
Last updated
02/27/2025
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