Provider Demographics
NPI:1497867931
Name:KHORFAN, FAHIM (MD)
Entity Type:Individual
Prefix:MR
First Name:FAHIM
Middle Name:
Last Name:KHORFAN
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 1:8220 S. SAGINAW ST
Mailing Address - Street 2:STE 800
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1890
Mailing Address - Country:US
Mailing Address - Phone:810-695-5864
Mailing Address - Fax:810-695-2412
Practice Address - Street 1:1513 S CENTER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1728
Practice Address - Country:US
Practice Address - Phone:810-742-0224
Practice Address - Fax:810-742-8768
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062310207RP1001X
MIFK062310207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2979742Medicaid
MI0B56209002Medicare ID - Type UnspecifiedMEDICARE
B66526Medicare UPIN
MI2979742Medicaid