Provider Demographics
NPI:1619400900
Name:KHAN, SAMI MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:SAMI
Middle Name:MOHAMMED
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 1:1000 REGENCY CT STE 100
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3074
Mailing Address - Country:US
Mailing Address - Phone:419-882-0588
Mailing Address - Fax:419-885-3070
Practice Address - Street 1:1000 REGENCY CT STE 100
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3074
Practice Address - Country:US
Practice Address - Phone:419-882-0588
Practice Address - Fax:419-885-3070
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301503661207W00000X
OH35145425207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0488596Medicaid
OH1619400900OtherPARAMOUNT HEALTH CARE