Healthcare Provider Details

I. General information

NPI: 1811786627
Provider Name (Legal Business Name): MUDASSIR KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 08/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 ST. ANTOINE, UHC 8C DETROIT MEDICAL CENTER/WAYNE S
DETROIT MI
48201
US

IV. Provider business mailing address

LENORA PAUL, PROGRAM COORDINATOR, NEUROLOGY FELLOWSHIPS 4201 ST. ANTOINE, UHC 8C
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-1243
  • Fax: 313-745-4216
Mailing address:
  • Phone: 313-577-1243
  • Fax: 313-745-4216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: