Provider Demographics
NPI:1679580104
Name:KHAWAJA, HASEEB A (MD)
Entity Type:Individual
Prefix:
First Name:HASEEB
Middle Name:A
Last Name:KHAWAJA
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 1:1921 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-2402
Mailing Address - Country:US
Mailing Address - Phone:586-840-1333
Mailing Address - Fax:586-840-1377
Practice Address - Street 1:1921 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2402
Practice Address - Country:US
Practice Address - Phone:586-840-1333
Practice Address - Fax:586-840-1377
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110009949Medicare PIN