Healthcare Provider Details

I. General information

NPI: 1093637266
Provider Name (Legal Business Name): INTEGRATIVE LIFESTYLE MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24712 MICHIGAN AVE STE 3
DEARBORN MI
48124-2478
US

IV. Provider business mailing address

24712 MICHIGAN AVE STE 3
DEARBORN MI
48124-2478
US

V. Phone/Fax

Practice location:
  • Phone: 313-438-6691
  • Fax: 313-406-3825
Mailing address:
  • Phone: 313-438-6691
  • Fax: 313-406-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHAR KHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 313-438-6691