Provider Demographics
NPI:1477728392
Name:MAHMOOD KHAN M.D., P.C.
Entity Type:Organization
Organization Name:MAHMOOD KHAN M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-389-5200
Mailing Address - Street 1:25880 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-1553
Mailing Address - Country:US
Mailing Address - Phone:313-389-5200
Mailing Address - Fax:313-389-4935
Practice Address - Street 1:25880 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-1553
Practice Address - Country:US
Practice Address - Phone:313-389-5200
Practice Address - Fax:313-389-4935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1794888Medicaid
MI0P56950Medicare PIN
MIE37404Medicare UPIN