MEDICARE: DR. NIDAH 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	207Q00000X	Family Medicine Physician	4301508376	MI

General Provider Information

NPI Number	:	1225747165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIDAH KHAN MD

Provider Business Mailing Address
First Line	:	3146 BRIMSTEAD DR
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-6224
Country	:	US
Telephone Number	:	615-351-8641
Fax Number	:

Provider Business Practice Location Address
First Line	:	3146 BRIMSTEAD DR
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-6224
Country	:	US
Telephone Number	:	615-351-8641
Fax Number	:

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

Provider Enumeration Date	:	11/18/2022
Last Update Date	:	11/18/2022

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