Provider Demographics
NPI:1255383865
Name:KHANNA, VIJAY K (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:K
Last Name:KHANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VIJAY
Other - Middle Name:KRISHAN
Other - Last Name:KHANNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:21801 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4213
Mailing Address - Country:US
Mailing Address - Phone:734-287-3830
Mailing Address - Fax:734-287-8302
Practice Address - Street 1:21801 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4213
Practice Address - Country:US
Practice Address - Phone:734-287-3830
Practice Address - Fax:734-287-8302
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVK032026207R00000X
173F00000X, 225B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173F00000XOther Service ProvidersSleep Specialist, PhD
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1069386-10Medicaid
MIOP47950Medicare PIN
A74573Medicare UPIN