Individual
DR. SHAKEEL KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5859 W TALAVI BLVD, SUITE 100, GLENDALE, AZ 85306-1870
(602) 298-7777
(623) 930-6060
Mailing address
5859 W TALAVI BLVD, SUITE 100, GLENDALE, AZ 85306-1869
(602) 298-7777
(623) 930-6060
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
40323
AZ
207RI0011X
Interventional Cardiology Physician
Primary
40323
AZ
207UN0901X
Nuclear Cardiology Physician
40323
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
356441
—
AZ
01
—
40323
AZ MEDICAL LICENSE
AZ
01
—
Z123706
MEDICARE PTAN
AZ
Enumeration date
10/10/2006
Last updated
08/24/2021
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