Healthcare Provider Details

I. General information

NPI: 1770144164
Provider Name (Legal Business Name): HIRA KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 RICHARDSON ST
PORT HURON MI
48060-3549
US

IV. Provider business mailing address

1216 RICHARDSON ST
PORT HURON MI
48060-3549
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-2640
  • Fax: 810-962-8294
Mailing address:
  • Phone: 810-985-2640
  • Fax: 810-962-8294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301507355
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: