Provider Demographics
NPI:1720490667
Name:KHURRAM, MUHAMMAD SIDDIQUE (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:SIDDIQUE
Last Name:KHURRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746559
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6559
Mailing Address - Country:US
Mailing Address - Phone:313-343-3133
Mailing Address - Fax:313-343-8318
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:313-343-3133
Practice Address - Fax:313-343-8318
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT3982207ZP0102X
MI4301102456207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology