Healthcare Provider Details

I. General information

NPI: 1487035127
Provider Name (Legal Business Name): SHEHRYAR KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

IV. Provider business mailing address

10300 W 8 MILE RD
FERNDALE MI
48220-2100
US

V. Phone/Fax

Practice location:
  • Phone: 616-281-6363
  • Fax:
Mailing address:
  • Phone: 248-398-3200
  • Fax: 248-691-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301500276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: