Individual
AISHA KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11751 ALTA VISTA RD, STE 103, FORT WORTH, TX 76244-6441
(972) 691-4100
Mailing address
11751 ALTA VISTA RD, STE 103, FORT WORTH, TX 76244-6441
(972) 691-4100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N8672
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
281353701
MEDICAID GROUP TPI
TX
01
—
281353702
MEDICAID EP1
TX
05
—
281356001
—
TX
Enumeration date
07/26/2007
Last updated
09/19/2012
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