Healthcare Provider Details

I. General information

NPI: 1427736867
Provider Name (Legal Business Name): ZUBIN KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MICHIGAN AVE STE 105
JACKSON MI
49201-2490
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-1223
  • Fax:
Mailing address:
  • Phone: 313-874-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601012880
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: