Provider Demographics
NPI:1063615904
Name:KHAN, SHAH-NAZ H (MD)
Entity type:Individual
Prefix:
First Name:SHAH-NAZ
Middle Name:H
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 CHARTER DR STE C
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3584
Mailing Address - Country:US
Mailing Address - Phone:810-212-4100
Mailing Address - Fax:810-250-4514
Practice Address - Street 1:1020 CHARTER DR STE C
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3584
Practice Address - Country:US
Practice Address - Phone:810-212-4100
Practice Address - Fax:810-250-4514
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062181207T00000X
OK40672207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1063615904Medicaid