Provider Demographics
NPI:1447330592
Name:KHAN, FARZANA RAHMAN (MD)
Entity type:Individual
Prefix:
First Name:FARZANA
Middle Name:RAHMAN
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N LAKEMONT AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3200
Mailing Address - Country:US
Mailing Address - Phone:407-644-7400
Mailing Address - Fax:407-644-2970
Practice Address - Street 1:201 N LAKEMONT AVE STE 500
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3200
Practice Address - Country:US
Practice Address - Phone:407-644-7400
Practice Address - Fax:407-644-2970
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 64960261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7256498003OtherCIGNA
FL7628211OtherAETNA
FL1201344OtherUNITED HEALTHCARE
FL219821Medicaid
FL28481OtherBCBS
FL189678Medicaid