MEDICARE: DR. BADER FATIMA KHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	4301065296	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174593966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BADER FATIMA KHAN MD

Provider Business Mailing Address
First Line	:	1639 IMAN RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-2263
Country	:	US
Telephone Number	:	734-634-8242
Fax Number	:

Provider Business Practice Location Address
First Line	:	8528 N CANTON CENTER RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-1310
Country	:	US
Telephone Number	:	734-414-9944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	12/03/2020

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