Healthcare Provider Details

I. General information

NPI: 1194911941
Provider Name (Legal Business Name): RENAL ASSOCIATES OF MID-MICHIGAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W WACKERLY ST
MIDLAND MI
48640-2739
US

IV. Provider business mailing address

415 W WACKERLY ST
MIDLAND MI
48640-2739
US

V. Phone/Fax

Practice location:
  • Phone: 989-837-6505
  • Fax: 989-835-8428
Mailing address:
  • Phone: 989-837-6505
  • Fax: 989-835-8428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: ADEEL KHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 989-837-6505