Moniruzzaman Khan, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MK057394 Issued in MI

Practice address

4402 E 9 Mile Rd
Warren, MI 48091-2590

Phone

(586) 200-0611

Fax

(586) 381-7055

NPI assigned

Jun 6, 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 9

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

Specialty

Pediatric Medicine

Education

Other, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hamtramck Pediatrics

  • Primary Care Clinic/Center
  • Hamtramck, MI
  • NPI 1033408935
  NPD (past) Authorized official
• Waterford Pediatrics

  • General Practice Physician
  • Waterford, MI
  • NPI 1104082148
  NPD (past)
• Waterford Urgent Care PC

  • Urgent Care Clinic/Center
  • Waterford, MI
  • NPI 1730525015
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• William Beaumont Hospital

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1689653305
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  Care Compare affiliation

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1477592905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4402 E 9 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480912590",
            "telephone_number": "586-200-0611",
            "fax_number": "586-381-7055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 E 9 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480912590",
            "telephone_number": "586-200-0611",
            "fax_number": "586-381-7055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11402 Joseph Campau St",
            "address_purpose": "LOCATION",
            "city": "Hamtramck",
            "state": "MI",
            "postal_code": "482123041",
            "country_code": "US",
            "telephone_number": "313-366-4000",
            "fax_number": "313-366-4001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MONIRUZZAMAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "MK057394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0634011",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PLAN",
            "identifier": "G97370",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPE HEALTH PLAN",
            "identifier": "1215B",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLAN OF MICH",
            "identifier": "15486",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "414952410",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICE",
            "identifier": "120911",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TOTAL HEALTH",
            "identifier": "6251",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "P105053",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "C7543",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hussain Khambati, DO
• Afshan Khan, D.O.
• Anusha Khan, MBBS
• Irtiah Khan, PA-C
• Mishal Khan
• Muhammad Yahya Khan, PT
• Rheaha Khan
• Safa Zaman Khan, DO
• Saima Aslam Khan, MD
• Sayeed Khan, MD

• General Practice Physician in Warren, MI
• Providers in Warren, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.