Healthcare Provider Details

I. General information

NPI: 1215074182
Provider Name (Legal Business Name): SAMEERA KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TOWNSHIP MI
48038-3504
US

IV. Provider business mailing address

15855 19 MILE RD
CLINTON TOWNSHIP MI
48038-3504
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2230
  • Fax: 586-263-2239
Mailing address:
  • Phone: 586-263-2230
  • Fax: 586-263-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301056720
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: