Provider Demographics
NPI:1134459662
Name:PARVEZ KHAN MD,PC
Entity Type:Organization
Organization Name:PARVEZ KHAN MD,PC
Other - Org Name:PARVEZ KHAN MD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARVEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-274-1800
Mailing Address - Street 1:861 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2308
Mailing Address - Country:US
Mailing Address - Phone:313-274-1800
Mailing Address - Fax:313-274-8717
Practice Address - Street 1:861 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2308
Practice Address - Country:US
Practice Address - Phone:313-274-1800
Practice Address - Fax:313-274-8717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPK047634261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101817650Medicaid
MI110019977OtherPALMETTO RAILROAD MEDICARE
MIA75852Medicare UPIN