Provider Demographics
NPI:1568946820
Name:KHAN, SAJID (MD)
Entity Type:Individual
Prefix:DR
First Name:SAJID
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 1:23892 WATERCREST CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2716
Mailing Address - Country:US
Mailing Address - Phone:248-987-8117
Mailing Address - Fax:
Practice Address - Street 1:9109 BAYMEADOWS RD STE 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1842
Practice Address - Country:US
Practice Address - Phone:904-420-7569
Practice Address - Fax:847-221-6792
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2021-12-26
Deactivation Date:2021-03-23
Deactivation Code:
Reactivation Date:2021-04-30
Provider Licenses
StateLicense IDTaxonomies
MN2557208D00000X
FLACN1161208D00000X
PATMD004428208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106420200Medicaid