Provider Demographics
NPI:1174664866
Name:TAWHIDA KHATOON MDPC
Entity Type:Organization
Organization Name:TAWHIDA KHATOON MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAWHIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-390-9507
Mailing Address - Street 1:55 E LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4738
Mailing Address - Country:US
Mailing Address - Phone:248-390-9507
Mailing Address - Fax:248-457-9403
Practice Address - Street 1:5301 MCAULEY DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1051
Practice Address - Country:US
Practice Address - Phone:734-712-3733
Practice Address - Fax:734-712-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4756746Medicaid
MI4756746Medicaid
MII24048Medicare UPIN