Healthcare Provider Details

I. General information

NPI: 1134169477
Provider Name (Legal Business Name): SAYEED KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12434 E 12 MILE RD SUITE 203
WARREN MI
48093-3536
US

IV. Provider business mailing address

PO BOX 432
BLOOMFIELD HILLS MI
48303-0432
US

V. Phone/Fax

Practice location:
  • Phone: 586-755-4333
  • Fax: 586-755-4744
Mailing address:
  • Phone: 586-755-4333
  • Fax: 586-755-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberSK072862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: