Healthcare Provider Details

I. General information

NPI: 1265000848
Provider Name (Legal Business Name): AZMATHULLAH KHAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 GREENFIELD RD
DEARBORN MI
48126-4124
US

IV. Provider business mailing address

4700 GREENFIELD RD
DEARBORN MI
48126-4124
US

V. Phone/Fax

Practice location:
  • Phone: 734-545-0634
  • Fax: 313-945-5365
Mailing address:
  • Phone: 734-545-0634
  • Fax: 313-945-5365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AZMATHULLAH KHAN
Title or Position: DOCTOR
Credential: MD
Phone: 734-545-0634