Provider Demographics
NPI:1467475277
Name:KHATOON, TAWHIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:TAWHIDA
Middle Name:
Last Name:KHATOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E LONG LAKE RD # 390
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:248-457-9403
Mailing Address - Fax:734-712-2719
Practice Address - Street 1:5301 MCAULEY DR
Practice Address - Street 2:OFFICE RM 4098
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4756746Medicaid
I24048Medicare UPIN
MI4756746Medicaid