Provider Demographics
NPI:1053336271
Name:KHAN, MUBINA (MD)
Entity type:Individual
Prefix:DR
First Name:MUBINA
Middle Name:
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 1:80600 VAN DYKE
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065
Mailing Address - Country:US
Mailing Address - Phone:810-798-6560
Mailing Address - Fax:810-798-6563
Practice Address - Street 1:80600 VAN DYKE
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065
Practice Address - Country:US
Practice Address - Phone:810-798-6500
Practice Address - Fax:810-798-6563
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4434798Medicaid
MIH72283Medicare UPIN
MIM23560130Medicare PIN