Provider Demographics
NPI:1023081742
Name:KHAN, FARHAN (MD)
Entity type:Individual
Prefix:DR
First Name:FARHAN
Middle Name:
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 1:6122 W PIERSON RD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-3104
Mailing Address - Country:US
Mailing Address - Phone:810-732-4007
Mailing Address - Fax:810-732-5559
Practice Address - Street 1:3433 FENTON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-235-1331
Practice Address - Fax:810-235-8656
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4377717Medicaid
ON4130Medicare ID - Type Unspecified
MI4377717Medicaid