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General NPI Number Information
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NPI Number | 1477791085
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Entity Type | Individual
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Provider Name | MASUD ALI KHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 432 PINE BRAE DRIVE
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City | ANN ARBOR
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State | MI
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Zip | 48105-2723
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Country | US
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Telephone | 734-668-7020
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Fax | 734-668-7020
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Provider Business Mailing Address
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Address Line | 432 PINE BRAE DRIVE
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City | ANN ARBOR
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State | MI
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Zip | 48105-2723
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Country | US
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Telephone | 734-668-7020
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Fax | 734-668-7020
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301033244
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License Number State | MI
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