Healthcare Provider Details

I. General information

NPI: 1134100175
Provider Name (Legal Business Name): IFTIKHAR A KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 TOWNE CENTRE RD SUITE 302
SAGINAW MI
48604-2818
US

IV. Provider business mailing address

4705 TOWNE CENTRE RD SUITE 302
SAGINAW MI
48604-2818
US

V. Phone/Fax

Practice location:
  • Phone: 989-799-2640
  • Fax: 989-799-8222
Mailing address:
  • Phone: 989-799-2640
  • Fax: 989-799-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number4301072871
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number4301072871
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number4301072871
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number4301072871
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number4301072871
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301072871
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: