Provider Demographics
NPI:1497020879
Name:KHAJA, DAANISH
Entity Type:Individual
Prefix:
First Name:DAANISH
Middle Name:
Last Name:KHAJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 ALAMEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-6733
Mailing Address - Country:US
Mailing Address - Phone:513-295-3565
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.062376207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology