Organization
FAREESA KHAN LLC
Active
Organization
FAREESA KHAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAREESA G KHAN MD (OWNER)
(636) 675-3107
Entity
Organization
Contact information
Practice address
10004 KENNERLY RD STE 255A, SAINT LOUIS, MO 63128-2184
(314) 270-9880
Mailing address
PO BOX 410085, SAINT LOUIS, MO 63141-0085
(636) 675-3107
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
112917
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203820014
—
MO
Enumeration date
02/01/2013
Last updated
07/10/2020
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