Provider Demographics
NPI:1467481465
Name:KHAN, ADEEL (MD)
Entity Type:Individual
Prefix:
First Name:ADEEL
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2761
Mailing Address - Country:US
Mailing Address - Phone:989-837-6505
Mailing Address - Fax:989-835-8428
Practice Address - Street 1:415 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2761
Practice Address - Country:US
Practice Address - Phone:989-837-6505
Practice Address - Fax:989-835-8428
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062170207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1006835OtherMCLAREN HEALTH PLAN
MI1011192OtherMCLAREN HEALTH PLAN
MI1032653OtherMCLAREN
MI200000014300OtherPHP COML.
MI4584928Medicaid
MI1105610461OtherBCBSM
MI0989454OtherHEALTHPLUS COMMERCIAL
MI200000005783OtherPHP COMMERCIAL
MI4584928Medicaid
MI0989454OtherHEALTHPLUS COMMERCIAL
MI1006835OtherMCLAREN HEALTH PLAN
MIP58230001Medicare PIN