Organization
ADVANCED NEURODIAGNOSTIC CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AHTARAM M KHAN M.D. (MEDICAL DIRECTOR)
(972) 980-0015
Entity
Organization
Contact information
Practice address
1705 OHIO DR, SUITE 200, PLANO, TX 75093-5255
(866) 620-5987
Mailing address
PO BOX 794564, DALLAS, TX 75379-4564
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
Primary
L1628
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L1628
TEXAS LICENSE NUMBER
—
Enumeration date
09/15/2011
Last updated
12/21/2011
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