Individual
IMTIAZ R KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2223 QUAIL RUN STE E, BATON ROUGE, LA 70808-9063
(225) 877-2872
Mailing address
2223 QUAIL RUN STE E, BATON ROUGE, LA 70808-9063
(225) 877-2872
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
313117
LA
208600000X
Surgery Physician
4301505573
MI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
313117
LA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
4301505573
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56868
—
LA
Enumeration date
04/21/2011
Last updated
11/16/2021
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