Mukhtar Ahmad Khan, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

MK044345 Issued in MI

Practice address

25779 Kelly Rd
Suite C
Roseville, MI 48066-4973

Phone

(586) 774-0700

Fax

(586) 774-9841

NPI assigned

Sep 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306948435",
    "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": {
        "last_name": "KHAN",
        "first_name": "MUKHTAR",
        "middle_name": "AHMAD",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "MK044345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "P41411",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2898009",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily A Kempton
• Apostolos George Kerasiotis, D.P.T.
• Kerri S. Gustafson, DDS, PLLC, Dentistry for Children
• Keshinudan Inc.
• Quresh Khairullah, MD
• Saira Nishath Khan, O.D.
• Shahid Ali Khan, D.C.
• Kidney Consultants of Michigan PC
• Tiffany Ann Kilcline, COTAL
• Carolyn Kimble, LLPC

• Cardiovascular Disease Physician in Roseville, MI
• Providers in Roseville, MI by specialty
• Cardiovascular Disease Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.