Provider Demographics
NPI:1689771099
Name:KHAN, MUHAMMAD UMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:UMAR
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 1:801 JOE MANN BLVD STE P-6
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8900
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:912 S WASHINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2578
Practice Address - Country:US
Practice Address - Phone:989-791-7900
Practice Address - Fax:989-791-4114
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0730424OtherBCBSM PIN
MI4338423Medicaid
MI700G360210OtherBCBSM
MIMK078850OtherLICENSE
MI381870664OtherTAX ID
MI381870664125OtherCOMMUNITY CHOICE MICHIGAN
MI0991564OtherHEALTHPLUS OF MICHIGAN
MI101464OtherGREAT LAKES HEALTH PLAN
MI440003563OtherRAILROAD MEDICARE
MI1012415OtherMCLAREN
MI0730424OtherBCBSM PIN
MI381870664125OtherCOMMUNITY CHOICE MICHIGAN
MI0G36021Medicare ID - Type UnspecifiedMEDICARE GROUP
MI0991564OtherHEALTHPLUS OF MICHIGAN