Healthcare Provider Details

I. General information

NPI: 1619357068
Provider Name (Legal Business Name): ROHIN KHANNA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date: 01/15/2016
Reactivation Date: 02/08/2016

III. Provider practice location address

1215 E MICHIGAN AVE SUITE 245
LANSING MI
48912
US

IV. Provider business mailing address

1200 E MICHIGAN AVE SUITE 245
LANSING MI
48912
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-1000
  • Fax:
Mailing address:
  • Phone: 517-364-5772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301107399
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: