Provider Demographics
NPI:1972036317
Name:KHAN, ANAM ALI (MD)
Entity Type:Individual
Prefix:
First Name:ANAM
Middle Name:ALI
Last Name:KHAN
Suffix:
Gender:F
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:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-780-2455
Mailing Address - Fax:
Practice Address - Street 1:4705 TOWNE CENTRE RD STE 204
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2819
Practice Address - Country:US
Practice Address - Phone:989-780-2455
Practice Address - Fax:989-401-8485
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301502878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine