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General NPI Number Information
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NPI Number | 1033631858
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Entity Type | Individual
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Provider Name | HASSAN KHAN DO
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Gender | Male
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2560 LYNWOOD DR
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City | TROY
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State | MI
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Zip | 48083-5681
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Country | US
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Telephone | 515-650-3031
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Fax |
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Provider Business Mailing Address
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Address Line | 2560 LYNWOOD DR
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City | TROY
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State | MI
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Zip | 48083-5681
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Country | US
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Telephone | 515-650-3031
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Fax |
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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 | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | 5101024463
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101023587
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License Number State | MI
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