Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301009421 | MI |
N | 111NI0013X | Independent Medical Examiner | 2301009421 | MI |
N | 111NP0017X | Pediatric Chiropractor | 2301009421 | MI |
N | 111NR0400X | Rehabilitation Chiropractor | 2301009421 | MI |
N | 111NX0100X | Occupational Health | 2301009421 | MI |
N | 225100000X | Physical Therapist | 2301009421 | MI |
NPI | 1568609246 |
---|---|
Provider Name | Dr. Shahid Ali Khan |
First Address | Roseville, MI 48066-4803 |
Second Address | Roseville, MI 48066-4803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2009 |
Last Update Date | 08/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0N23370010 | (02) | MI |
68504 | HEALTH PLAN OF MICHIGAN (01) | MI |
MK009421 | BCBS OF MI (01) | MI |