Individual
ILYAS MOHAMMED KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
209 GASLIGHT BLVD, LUFKIN, TX 75904-3134
(936) 632-8787
Mailing address
310 GASLIGHT BLVD, LUFKIN, TX 75904-3133
(936) 632-8787
(936) 632-8832
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
274581
NY
207RC0000X
Cardiovascular Disease Physician
Primary
Q1680
TX
207RI0011X
Interventional Cardiology Physician
Q1680
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03828824
—
NY
05
—
341967301
—
TX
Enumeration date
09/26/2009
Last updated
01/09/2024
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