Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 4301031939 | MI |
NPI | 1013907328 |
---|---|
Provider Name | Dr. Mohammed Jamil Ahmed Khan |
First Address | Port Huron, MI 48060-3549 |
Second Address | Port Huron, MI 48060-3549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 14/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2108970 | (05) | MI |
E38084 | (02) |