Healthcare Provider Details

I. General information

NPI: 1831360031
Provider Name (Legal Business Name): BILAL AHMAD KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD HENRY FORD HOSPITAL
DETROIT MI
48202-2608
US

IV. Provider business mailing address

1350 W BETHUNE ST APT 1110
DETROIT MI
48202-2600
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2020
  • Fax: 313-916-5555
Mailing address:
  • Phone: 313-758-0492
  • Fax: 313-916-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301081294
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD037324
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: