Provider Demographics
NPI:1659408144
Name:KHAN, ZAKIUDDIN AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:ZAKIUDDIN
Middle Name:AHMED
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 1:3257 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2909
Mailing Address - Country:US
Mailing Address - Phone:810-664-3396
Mailing Address - Fax:810-664-8036
Practice Address - Street 1:3257 DAVISON RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2909
Practice Address - Country:US
Practice Address - Phone:810-664-3396
Practice Address - Fax:810-664-8036
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040735174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1175082OtherHEALTH PLUS
MI1659408144OtherHEALTH ALLIANCE PLAN
MI2102636Medicaid
MI10898330OtherCAQH
MI10898330OtherCAQH