Provider Demographics
NPI:1720164700
Name:KHAN, ABDUL ALEEM (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:ALEEM
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 1:12345 TELEGRAPH RD STE 9
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6860
Mailing Address - Country:US
Mailing Address - Phone:313-571-1200
Mailing Address - Fax:
Practice Address - Street 1:12345 TELEGRAPH RD STE 9
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6860
Practice Address - Country:US
Practice Address - Phone:313-265-0627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010715052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
36036OtherHEALTH PLAN OF MICHIGAN
530558OtherVALUE OPTIONS
H71202OtherHAP
MI104690368Medicaid
9374069OtherPHCS
2608233242OtherBCBS
024240OtherMIDWEST HEALTH PLAN
024240OtherMIDWEST HEALTH PLAN
H71202Medicare UPIN