| Doctor Name: | DR. SIDDIQ AHMED KHAN |
| NPI Number: | 1811339203 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D |
| License Number: | ME 116020 |
| Business Practice Address: | 2201 N Broadwell Ave Grand Island, NE - 688032153 |
| Business Phone Number: | 3083823660 |
| Business Fax Number: | 3083895111 |
| Mailing Address: | 2201 N Broadwell Ave, GRAND ISLAND |
| State: | NE |
| Postal Code: | 688032153 |
| Phone Number: | 3083823660 |
| Fax Number: | 3083895111 |
| NPI Enumeration Date: | 07/25/2013 |
| NPI Last Update Date: | 07/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME 116020 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |