Individual
ATIYA S. KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11115 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 266-5400
(260) 266-5405
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
01059831A
IN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
01059831A
IN
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
01059831A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200507010
—
IN
05
—
2168078
—
OH
05
—
4851469
—
MI
01
—
P00200805
RR MEDICARE
IN
Enumeration date
06/30/2005
Last updated
10/17/2022
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