Provider Demographics
NPI:1275710873
Name:KHAN, ABID R (MD)
Entity Type:Individual
Prefix:
First Name:ABID
Middle Name:R
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-1466
Mailing Address - Country:US
Mailing Address - Phone:989-802-5091
Mailing Address - Fax:989-802-5083
Practice Address - Street 1:602 BEECH ST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1466
Practice Address - Country:US
Practice Address - Phone:989-802-5091
Practice Address - Fax:989-802-5083
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091294207L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology