Basic Information
| Provider Information | |||||||||
| NPI: | 1134459662 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARVEZ KHAN MD,PC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | PARVEZ KHAN MD, PC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 861 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481242308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132741800 | ||||||||
| FaxNumber: | 3132748717 | ||||||||
| Practice Location | |||||||||
| Address1: | 861 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481242308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132741800 | ||||||||
| FaxNumber: | 3132748717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2010 | ||||||||
| LastUpdateDate: | 04/25/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | PARVEZ | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3132741800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0200X | PK047634 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology |
ID Information
| ID | Type | State | Issuer | Description | 101817650 | 05 | MI | MEDICAID | 110019977 | 01 | MI | PALMETTO RAILROAD MEDICARE | OTHER |