Provider Demographics
NPI:1669172813
Name:KHAN, FATIMA BEGUM (MS, LLP)
Entity type:Individual
Prefix:MS
First Name:FATIMA
Middle Name:BEGUM
Last Name:KHAN
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 MCAULEY DRIVE, SUITE 2010
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1095
Mailing Address - Country:US
Mailing Address - Phone:734-712-4009
Mailing Address - Fax:734-712-8678
Practice Address - Street 1:5333 MCAULEY DR. SUITE 2010
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1095
Practice Address - Country:US
Practice Address - Phone:734-712-4009
Practice Address - Fax:734-712-8678
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361006241103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist