Provider Demographics
NPI:1184615205
Name:KHAN, PARVEZ (MD)
Entity type:Individual
Prefix:DR
First Name:PARVEZ
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 1:861 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2308
Mailing Address - Country:US
Mailing Address - Phone:313-274-0774
Mailing Address - Fax:313-274-8717
Practice Address - Street 1:861 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2308
Practice Address - Country:US
Practice Address - Phone:313-274-0774
Practice Address - Fax:313-274-8717
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI047634207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101817650Medicaid
MI0N97990Medicare PIN
MIA75852Medicare UPIN