Healthcare Provider Details

I. General information

NPI: 1417065855
Provider Name (Legal Business Name): AZADEH KHAGHANY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 STEWART RD
MONROE MI
48162-4393
US

IV. Provider business mailing address

313 STEWART RD
MONROE MI
48162-4393
US

V. Phone/Fax

Practice location:
  • Phone: 734-244-5560
  • Fax: 734-244-5078
Mailing address:
  • Phone: 734-244-5560
  • Fax: 734-244-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301070712
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: