MEDICARE: MAHMOOD KHAN M.D., P.C.

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	4301031737	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	:	1477728392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHMOOD KHAN M.D., P.C.

Provider Business Mailing Address
First Line	:	25880 OUTER DR
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-1553
Country	:	US
Telephone Number	:	313-389-5200
Fax Number	:	313-389-4935

Provider Business Practice Location Address
First Line	:	25880 OUTER DR
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-1553
Country	:	US
Telephone Number	:	313-389-5200
Fax Number	:	313-389-4935

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MAHMOOD KHAN
Credential	:	M.D.
Telephone Number	:	313-389-5200

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	11/09/2010

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