Individual
DR. EHTISHAM R. KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8371 HIGHWAY 72 W, SUITE 104, MADISON, AL 35758-9505
(256) 265-5970
(256) 817-5956
Mailing address
PO BOX 2705, HUNTSVILLE, AL 35804-2705
(256) 265-5970
(256) 817-5969
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
00019019
AL
207R00000X
Internal Medicine Physician
Primary
19019
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009932196
—
AL
05
—
109211
—
AL
01
—
515-96535
BLUE CROSS OF ALABAMA
AL
Enumeration date
06/12/2006
Last updated
12/09/2021
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