Healthcare Provider Details

I. General information

NPI: 1265639520
Provider Name (Legal Business Name): USMAN SAEED KHOKHAR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 03/19/2021
Certification Date: 02/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 PAGE AVE
JACKSON MI
49201-2419
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR PO BOX 0446 - LOBBY J
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-1234
  • Fax:
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number43010104450
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301104450
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: