Provider Demographics
NPI:1518983253
Name:KHAN, SHAFIQ AHMED
Entity Type:Individual
Prefix:MR
First Name:SHAFIQ
Middle Name:AHMED
Last Name:KHAN
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 1:16000 W 9 MILE RD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4808
Mailing Address - Country:US
Mailing Address - Phone:248-557-1265
Mailing Address - Fax:248-557-1267
Practice Address - Street 1:16000 W 9 MILE RD
Practice Address - Street 2:SUITE 610
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4808
Practice Address - Country:US
Practice Address - Phone:248-557-1265
Practice Address - Fax:248-557-1267
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5451550001Medicare NSC