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General NPI Number Information
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NPI Number | 1376617498
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Entity Type | Individual
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Provider Name | AHMED RAZA KHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | HENRY FORD HEALTH SYSTEM 2799 WEST GRAND BOULEVARD
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City | DETROIT
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State | MI
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Zip | 48202
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Country | US
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Telephone | 313-916-2436
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Fax |
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Provider Business Mailing Address
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Address Line | 601 ELMWOOD AVENUE BOX 604
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City | ROCHESTER
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State | NY
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Zip | 14642-0001
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Country | US
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Telephone | 585-275-2141
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 058157
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 058157
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 058157
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 186875
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License Number State | NY
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