Provider Demographics
NPI:1134100175
Name:KHAN, IFTIKHAR A (MD)
Entity type:Individual
Prefix:DR
First Name:IFTIKHAR
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4705 TOWNE CENTRE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2818
Mailing Address - Country:US
Mailing Address - Phone:989-799-2640
Mailing Address - Fax:989-799-8222
Practice Address - Street 1:4705 TOWNE CENTRE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2818
Practice Address - Country:US
Practice Address - Phone:989-799-2640
Practice Address - Fax:989-799-8222
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010728712084A2900X, 2084N0008X, 2084N0600X, 2084S0012X, 2084V0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4503394Medicaid
MIH11868Medicare UPIN
MI4503394Medicaid