Basic Information
| Provider Information | |||||||||
| NPI: | 1659347748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | MUHAMMAD | ||||||||
| MiddleName: | NAVEED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NAVEED | ||||||||
| OtherFirstName: | MUHAMMAD | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 211 S CRAPO ST | ||||||||
| Address2: | STE F | ||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488582961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897732081 | ||||||||
| FaxNumber: | 9897733418 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 S CRAPO ST | ||||||||
| Address2: | STE F | ||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488582961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897732081 | ||||||||
| FaxNumber: | 9897733418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 07/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 4301095281 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085U0001X | 4301095281 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0204X | 4301095281 | MI | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 34224800 | 05 | WI | MEDICAID |