Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 4301062181 | MI |
NPI | 1063615904 |
---|---|
Provider Name | Shah-Naz H Khan |
First Address | Flint, MI 48532-3584 |
Second Address | Flint, MI 48532-3584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 20/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063615904 | (05) | MI |