Provider Demographics
NPI:1811786627
Name:KHAN, MUDASSIR
Entity type:Individual
Prefix:
First Name:MUDASSIR
Middle Name:
Last Name:KHAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LENORA PAUL, PROGRAM COORDINATOR, NEUROLOGY FELLOWSHIPS
Mailing Address - Street 2:4201 ST. ANTOINE, UHC 8C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-577-1243
Mailing Address - Fax:313-745-4216
Practice Address - Street 1:4201 ST. ANTOINE, UHC 8C DETROIT MEDICAL CENTER/WAYNE S
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-577-1243
Practice Address - Fax:313-745-4216
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program