Active NPI
Mariam Khan
- Periodontics
- Detroit, MI
National Provider Identifier
1730780933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 2901600674
- Practice address
- 2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576 - Phone
- (313) 494-6700
- NPI assigned
- Nov 4, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 2901600674 | MI | Primary |
Addresses
Primary practice location
2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576
Mailing address
200 Riverfront Dr Apt 22G
Detroit, MI 48226-7580
Phone (516) 996-2851
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | khanma12@udmercy.edu |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604448000000",
"number": "1730780933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 RIVERFRONT DR APT 22G",
"city": "DETROIT",
"state": "MI",
"postal_code": "482267580",
"telephone_number": "516-996-2851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 MARTIN LUTHER KING JR BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482082576",
"telephone_number": "313-494-6700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "MARIAM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-04",
"last_updated": "2020-11-04",
"certification_date": "2020-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Periodontics",
"state": "MI",
"license": "2901600674",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "khanma12@udmercy.edu",
"affiliation": "N",
"address_1": "2700 Martin Luther King Jr Blvd",
"city": "Detroit",
"state": "MI",
"country_code": "US",
"postal_code": "482082576",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.