Provider Demographics
NPI:1326231325
Name:KHAN, SYED MAHMOOD ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:MAHMOOD ALI
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29992 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3292
Mailing Address - Country:US
Mailing Address - Phone:248-851-1430
Mailing Address - Fax:248-851-5281
Practice Address - Street 1:27483 DEQUINDRE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3491
Practice Address - Country:US
Practice Address - Phone:248-544-9050
Practice Address - Fax:248-544-2331
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010408062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB44097Medicare UPIN