Provider Demographics
NPI:1285679027
Name:AWAN, MUZAFFAR KHAN (MD)
Entity Type:Individual
Prefix:
First Name:MUZAFFAR
Middle Name:KHAN
Last Name:AWAN
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 1:7105 ALLEN ROAD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101
Mailing Address - Country:US
Mailing Address - Phone:313-381-7130
Mailing Address - Fax:313-381-0721
Practice Address - Street 1:7105 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2009
Practice Address - Country:US
Practice Address - Phone:313-381-7130
Practice Address - Fax:313-381-0721
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010469652081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA74507Medicare UPIN