Provider Demographics
NPI:1336934249
Name:KHAN, ALI RAZA (MBBS)
Entity type:Individual
Prefix:
First Name:ALI RAZA
Middle Name:
Last Name:KHAN
Suffix:
Gender:
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40675 DEER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188
Mailing Address - Country:US
Mailing Address - Phone:734-673-3769
Mailing Address - Fax:
Practice Address - Street 1:TRINITY HEALTH ACADEMIC INTERNAL MEDICINE-NORTHWEST LIV
Practice Address - Street 2:37595 SEVEN MILE RD, SUITE 340
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-793-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program