1053553107 NPI number — M N KHAN PC

Table of content: (NPI 1053553107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053553107 NPI number — M N KHAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M N KHAN PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053553107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6074 ORCHARD RIDGE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48322-2439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-320-7164
Provider Business Mailing Address Fax Number:
248-758-2060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43368 WOODWARD AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48302-5051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-758-0730
Provider Business Practice Location Address Fax Number:
248-758-2060
Provider Enumeration Date:
04/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
NADEEM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-320-7164

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301063986 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1106322821 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3308054 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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