Mir Mujtaba Ali Khan, D.O.
Individual provider Active NPI Internal Medicine Physician · Huntsville, TX
NPI 1831290923 · NPPES record last updated May 30, 2023
Key facts
- NPI
- 1831290923
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- M3450 (TX)
- Practice address
- 179 Interstate 45 S
Suite 300
Huntsville, TX 77340-4223 - Phone
- (936) 294-0152
- Fax
- (936) 294-9600
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- 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 |
|---|---|---|---|---|
| I20090317000597 | TX | Practitioner - Internal Medicine |
4880751924 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M3450 | TX | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christus Trinity Clinic Texas | Internal Medicine | Current |
Accepting new patients |
| Christus Trinity Clinic Texas | Current |
Accepting new patients | |
| PCP for Life PA | Internal Medicine | Past |
Accepting new patients |
| Burhani Surgical LTD PLLC | Past | Accepting new patients |
Locations
630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888
800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/ABHJAA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | M3450 | TX | Yes |
Addresses
Primary practice location
179 Interstate 45 S
Suite 300
Huntsville, TX 77340-4223
Mailing address
179 Interstate 45 S
Suite 300
Huntsville, TX 77340-4223
Phone (936) 294-0152
Other practice location 1
800 E Dawson St
Tyler, TX 75701-2036
Phone (903) 606-7264
Other names
- Dr. Mujtaba Ali-Khan
Other providers in Huntsville, TX
- Caitlyn Aizpiri
- Qussay Al Jawhar
- Sarah Dawn Alaway
- Asha Alexander
- Elizabeth Alexander
- Lisa Liang Alicea
- Elizabeth Paige Latiolais Allen
- Phillip L Allred
- Omar Akram Alnafoosi
- Victor Neftali Alvarado
All providers in Huntsville, TX · Internal Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2023. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.