Provider Demographics
NPI:1225549405
Name:KHAN, IKRAMUDDIN AHMED (PT)
Entity Type:Individual
Prefix:
First Name:IKRAMUDDIN
Middle Name:AHMED
Last Name:KHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24402 EL MARCO DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2043
Mailing Address - Country:US
Mailing Address - Phone:781-325-3079
Mailing Address - Fax:
Practice Address - Street 1:24402 EL MARCO DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2043
Practice Address - Country:US
Practice Address - Phone:781-325-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist