Provider Demographics
NPI:1871691386
Name:KHAN, SOHAIL M (MD)
Entity type:Individual
Prefix:DR
First Name:SOHAIL
Middle Name:M
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-2356
Mailing Address - Country:US
Mailing Address - Phone:850-271-3006
Mailing Address - Fax:850-271-4113
Practice Address - Street 1:1000 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-2356
Practice Address - Country:US
Practice Address - Phone:850-271-3006
Practice Address - Fax:850-271-4113
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069895174400000X
FLME69895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379856900Medicaid
FLK8524Medicare ID - Type Unspecified
FL379856900Medicaid