Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | MI |
NPI | 1518983253 |
---|---|
Provider Name | Mr. Shafiq Ahmed Khan |
First Address | Southfield, MI 48075-4808 |
Second Address | Southfield, MI 48075-4808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 05/11/2007 |