Provider Demographics
NPI:1790733129
Name:KHAGHANY, MOHAMMAD M (MD)
Entity Type:Individual
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First Name:MOHAMMAD
Middle Name:M
Last Name:KHAGHANY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1722 SHAFFER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1633
Mailing Address - Country:US
Mailing Address - Phone:269-343-1555
Mailing Address - Fax:269-343-3209
Practice Address - Street 1:1722 SHAFFER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1633
Practice Address - Country:US
Practice Address - Phone:269-343-1555
Practice Address - Fax:269-343-3209
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-11-06
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Provider Licenses
StateLicense IDTaxonomies
MI039427208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4240560Medicaid
MI03931791OtherBLUE CROSS BLUE SHIELD
MIA73780Medicare UPIN
MIP33680003Medicare PIN