Provider Demographics
NPI:1922197938
Name:KHAN, MUHAMMAD YAHYA (PT)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:YAHYA
Last Name:KHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29150 HEMLOCK CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2112
Mailing Address - Country:US
Mailing Address - Phone:734-323-5025
Mailing Address - Fax:586-979-8252
Practice Address - Street 1:31150 HOOVER RD
Practice Address - Street 2:STE C
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-7618
Practice Address - Country:US
Practice Address - Phone:734-323-5025
Practice Address - Fax:586-979-8252
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00196720OtherRAILROAD MEDICARE
MI0N83070Medicare ID - Type Unspecified