Provider Demographics
NPI:1861594277
Name:KHAN, QAMAR A (MD)
Entity type:Individual
Prefix:DR
First Name:QAMAR
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21333 HAGGERTY RD.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5514
Mailing Address - Country:US
Mailing Address - Phone:248-662-0250
Mailing Address - Fax:248-662-9845
Practice Address - Street 1:729 S. NORTON
Practice Address - Street 2:
Practice Address - City:CORUNNA
Practice Address - State:MI
Practice Address - Zip Code:48817-1207
Practice Address - Country:US
Practice Address - Phone:989-742-3491
Practice Address - Fax:313-369-3969
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301034351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5058362Medicaid
MIP00371277OtherRAILROAD MEDICARE
MIP00371277OtherRAILROAD MEDICARE
MIN98700011Medicare PIN
OM037210004Medicare ID - Type Unspecified