Provider Demographics
NPI:1043284219
Name:NEDD, KHAN JAVAN (MD)
Entity Type:Individual
Prefix:
First Name:KHAN
Middle Name:JAVAN
Last Name:NEDD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3230 EAGLE PARK DR NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7007
Mailing Address - Country:US
Mailing Address - Phone:616-954-0600
Mailing Address - Fax:616-954-1675
Practice Address - Street 1:3230 EAGLE PARK DR NE
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7007
Practice Address - Country:US
Practice Address - Phone:616-954-0600
Practice Address - Fax:616-954-1675
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406762207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B49362Medicare UPIN