Healthcare Provider Details

I. General information

NPI: 1881943256
Provider Name (Legal Business Name): AYAZ MAHMOOD KHAWAJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31500 TELEGRAPH RD STE 115
BINGHAM FARMS MI
48025-4302
US

IV. Provider business mailing address

6632 TELEGRAPH RD STE 204
BLOOMFIELD HILLS MI
48301-3012
US

V. Phone/Fax

Practice location:
  • Phone: 248-621-9100
  • Fax: 248-621-9111
Mailing address:
  • Phone: 248-621-9100
  • Fax: 248-621-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2018-02682
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number84632
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number19314
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberE-12548
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC175430
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036.158790
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301500203
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberE-12548
License Number StateAR
# 9
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA11301000
License Number StateNJ
# 10
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number75945-20
License Number StateWI
# 11
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number266021
License Number StateMA
# 12
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number296492
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: