Provider Demographics
NPI:1669504718
Name:KHAWAJA HABIBUR REHMAN MD PC
Entity Type:Organization
Organization Name:KHAWAJA HABIBUR REHMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHAWAJA
Authorized Official - Middle Name:H
Authorized Official - Last Name:REHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-780-3398
Mailing Address - Street 1:1200 N WEST AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2179
Mailing Address - Country:US
Mailing Address - Phone:517-780-3398
Mailing Address - Fax:517-796-4522
Practice Address - Street 1:1200 N WEST AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2179
Practice Address - Country:US
Practice Address - Phone:517-780-3398
Practice Address - Fax:517-796-4522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0461922Medicare PIN