MEDICARE: MR. KIANOUSH KHAGHANY 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	207V00000X	Obstetrics & Gynecology Physician	4301072919	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00215065	OTHER	MI	RAILROAD MEDICARE

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
2	1605802182	OTHER	MI	BLUE CROSS BLUE SHIELD
4	04232	OTHER	MI	PARAMOUNT
5	7626369	OTHER	MI	AETNA
6	1605802182	OTHER	MI	BLUE CARE NETWORK
7	16945	OTHER	MI	MCARE
8	20630	OTHER	MI	HEALTHPLAN OF MICHIGAN

General Provider Information

NPI Number	:	1619959772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KIANOUSH KHAGHANY MD

Provider Business Mailing Address
First Line	:	1 FORD PL STE 3A
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3450
Country	:	US
Telephone Number	:	313-874-4806
Fax Number	:	734-457-4030

Provider Business Practice Location Address
First Line	:	16151 19 MILE RD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1158
Country	:	US
Telephone Number	:	586-263-2308
Fax Number	:

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	12/11/2025

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