=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174861959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCESS BEHAVIORAL CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2013
-----------------------------------------------------
Last Update Date | 04/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24714 MICHIGAN AVE
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48124-1750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-438-6691
-----------------------------------------------------
Fax | 313-406-3825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24714 MICHIGAN AVE
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48124-1750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-438-6691
-----------------------------------------------------
Fax | 313-406-3825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ASHAR H. KHAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 313-438-6691
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------