Provider Demographics
NPI:1053553107
Name:M N KHAN PC
Entity type:Organization
Organization Name:M N KHAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:NADEEM
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-320-7164
Mailing Address - Street 1:6074 ORCHARD RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2439
Mailing Address - Country:US
Mailing Address - Phone:248-320-7164
Mailing Address - Fax:248-758-2060
Practice Address - Street 1:43368 WOODWARD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5051
Practice Address - Country:US
Practice Address - Phone:248-758-0730
Practice Address - Fax:248-758-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063986207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106322821OtherBLUE CROSS BLUE SHIELD
MI3308054Medicaid
MIMI1731Medicare PIN
MI3308054Medicaid