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NPI Code Detail

MEDICARE: IMADH KHAN

MEDICARE: IMADH KHAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program4351055870MI

General Provider Information

NPI Number : 1417894767
Entity Type Code : Individual
Provider Name (Legal Business Name) : IMADH KHAN
Provider Business Mailing Address
First Line : 1500 E MEDICAL CENTER DRIVE
Second Line : UH B1 502, SPC 5030
City : ANN ARBOR
State : MI
Zip : 48109
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1500 E MEDICAL CENTER DRIVE
Second Line : UH B1 502, SPC 5030
City : ANN ARBOR
State : MI
Zip : 48109
Country : US
Telephone Number : 734-615-4924
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2026
Last Update Date : 05/04/2026

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Directions to “ IMADH KHAN ” Practice Location

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