Ahmad Zia Khan, M.D.
Individual provider Active NPI Psychiatry Physician · Sturtevant, WI
NPI 1629065404 · NPPES record last updated Mar 28, 2018
Key facts
- NPI
- 1629065404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 41158-020 (WI)
- Practice address
- 8700 Durand Ave Ste 600
Sturtevant, WI 53177-2096 - Phone
- (262) 635-5520
- Fax
- (262) 635-5530
- NPI assigned
- Oct 5, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Psychiatric Services of Racine LLP
Practice addresses (Care Compare)
8700 Durand Ave
Suite 600
Sturtevant, WI 53177-2096
Phone (262) 635-5520
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090129000250 | WI | Practitioner - Psychiatry | 2769546118 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41158-020 | WI | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychiatric Services of Racine, LLP | Current |
Accepting new patients |
Locations
1244 Wisconsin Ave
Ste 303
Racine, WI 53403
Phone (262) 635-5520
8700 Durand Ave
Ste 600
Sturtevant, WI 53177
Phone (262) 635-5520
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 41158-020 | WI | Yes |
Addresses
Primary practice location
8700 Durand Ave Ste 600
Sturtevant, WI 53177-2096
Mailing address
8700 Durand Ave Ste 600
Sturtevant, WI 53177-2096
Phone (262) 635-5520
Other practice location 1
1244 Wisconsin Ave
Suite 303
Racine, WI 53403-1987
Phone (262) 635-5520
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32554100 | Medicaid | WI |
Other providers in Sturtevant, WI
- Douglas Mark Hinson
- Islam Alaa Ibrahim Mahdy Ibrahim
- Sahar A Karimuddin
- Jeremy L Kaup
- Jason A Kempinski
- Lori Ann Koralewski
- Jeanie Marie Kramer I
- Michelene C Larrabee
- Sharleen Leonard
- Thomas H Lim
All providers in Sturtevant, WI · Psychiatry Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.