MEDICARE: DR. AYESHA KHAN M.D.

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	207R00000X	Internal Medicine Physician	4301086138	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00237171	OTHER	MI	METRAHEALTH RR
2	AK086138	OTHER	MI	BCBS OF MI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	700F325300	OTHER	MI	BCN

General Provider Information

NPI Number	:	1275583882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYESHA KHAN M.D.

Provider Business Mailing Address
First Line	:	912 S WASHINGTON AVE
Second Line	:	STE B
City	:	SAGINAW
State	:	MI
Zip	:	48601-2578
Country	:	US
Telephone Number	:	248-662-0250
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 S WASHINGTON AVE
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48601-2564
Country	:	US
Telephone Number	:	989-791-7900
Fax Number	:	989-791-4114

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	11/07/2017

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