Organization
SHUJATH ALI KHAN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN WALLS (OFFICE MANAGER)
(405) 732-6223
Entity
Organization
Contact information
Practice address
8121 NATIONAL AVE, SUITE 401, MIDWEST CITY, OK 73110-7530
(405) 732-6223
Mailing address
8121 NATIONAL AVE, SUITE 401, MIDWEST CITY, OK 73110-7530
(405) 732-6223
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
207ZP0101X
Anatomic Pathology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861674251
RAILROAD MEDICARE
OK
05
—
1861674251
—
OK
Enumeration date
11/28/2007
Last updated
08/15/2008
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