Provider Demographics
NPI:1851485882
Name:KHAN, SEEMAB GUL (MD)
Entity type:Individual
Prefix:DR
First Name:SEEMAB
Middle Name:GUL
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 1:17876 FARMINGTON RD
Mailing Address - Street 2:BLDG C
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3104
Mailing Address - Country:US
Mailing Address - Phone:734-522-1406
Mailing Address - Fax:734-522-1407
Practice Address - Street 1:17876 FARMINGTON RD
Practice Address - Street 2:BLDG C
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3104
Practice Address - Country:US
Practice Address - Phone:734-522-1406
Practice Address - Fax:734-522-1407
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4270819Medicaid
MI1108290181OtherBCBS
MI4270819Medicaid
MI0P22310Medicare ID - Type Unspecified