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General NPI Number Information
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NPI Number | 1013907328
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Entity Type | Individual
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Provider Name | MOHAMMED JAMIL AHMED KHAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 06/14/2011
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Provider Practice Location Address
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Address Line | 1206 RICHARDSON ST
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City | PORT HURON
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State | MI
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Zip | 48060-3549
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Country | US
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Telephone | 810-984-4340
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Fax | 810-984-2303
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Provider Business Mailing Address
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Address Line | 1206 RICHARDSON ST
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City | PORT HURON
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State | MI
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Zip | 48060-3549
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Country | US
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Telephone | 810-984-4340
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Fax | 810-984-2303
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 4301031939
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License Number State | MI
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