NPIMap

Organization Active NPI

Mukhtar a Khan MD,Facc,PC

  • Cardiovascular Disease Physician
  • Roseville, MI
National Provider Identifier
1174625214
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MK044345 Issued in MI
Legal business name
MUKHTAR A KHAN MD,FACC,PC
Practice address
25779 Kelly Rd
Suite C
Roseville, MI 48066-4973
Phone
(586) 774-0700
Fax
(586) 774-9841
NPI assigned
Sep 1, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mukhtar Ahmad Khan, MD,FACC,CBNC,,PCNPI 1306948435
Title
Owner/Physician
Phone
(586) 774-0700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X MK044345 MI Primary

Addresses

Primary practice location

25779 Kelly Rd
Suite C
Roseville, MI 48066-4973

Mailing address

25779 Kelly Rd
Suite C
Roseville, MI 48066-4973
Phone (586) 774-0700

Other identifiers 1

IdentifierTypeStateIssuer
2898009MedicaidMI

National Provider Directory

National Provider Directory

Locations

25779 Kelly Rd
Ste C
Roseville, MI 48066
Phone (586) 774-0700

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174625214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25779 KELLY RD",
            "address_2": "SUITE C",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664973",
            "telephone_number": "586-774-0700",
            "fax_number": "586-774-9841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25779 KELLY RD",
            "address_2": "SUITE C",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664973",
            "telephone_number": "586-774-0700",
            "fax_number": "586-774-9841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUKHTAR A KHAN MD,FACC,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "MUKHTAR",
        "authorized_official_middle_name": "AHMAD",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "586-774-0700",
        "authorized_official_credential": "MD,FACC,CBNC,,PC"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "MK044345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2898009",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.