Individual
DR. MIRKUTUB M. KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4650 JEFFERSON LN NE, ALBUQUERQUE, NM 87109-2127
(505) 727-7900
(505) 727-7942
Mailing address
4650 JEFFERSON LN NE, ALBUQUERQUE, NM 87109-2127
(505) 727-7900
(505) 727-7942
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
77-199
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00023176
—
NM
01
—
253823
AHCCCS
NM
01
—
920003012
MEDICARE RAILROAD
NM
Enumeration date
06/13/2005
Last updated
10/01/2015
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