Provider Demographics
NPI:1629294483
Name:KHAN, ASGHAR (PT)
Entity Type:Individual
Prefix:
First Name:ASGHAR
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30041 ASTOR ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3517
Mailing Address - Country:US
Mailing Address - Phone:313-282-6424
Mailing Address - Fax:
Practice Address - Street 1:17555 JAMES COUZENS FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2657
Practice Address - Country:US
Practice Address - Phone:313-341-8895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP26405F (BCN)OtherPHYSICAL THERAPIST
MI0H257530 (BCBS)OtherPHYSICAL THERAPIST
MI0M87950Medicare ID - Type UnspecifiedPHYSICAL THERAPIST