Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 5315028414 | MI |
N | 208000000X | Pediatrician | 5315028414 | MI |
Y | 2080P0201X | Pediatric Allergist | 5315028414 | MI |
NPI | 1174700504 |
---|---|
Provider Name | Dr. Farah I Khan |
First Address | Detroit, MI 48201-2119 |
Second Address | Detroit, MI 48201-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2008 |
Last Update Date | 28/01/2008 |