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Organization

MINDSHAPE CLINIC PLC

Active
Other names
MindShape Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
HASSAN KHAN (MEDICAL DIRECTOR)
(515) 650-3031
Entity
Organization

Contact information

Practice address
2560 LYNWOOD DR STE 3, TROY, MI 48083-5681
(515) 650-3031
Mailing address
2560 LYNWOOD DR, TROY, MI 48083-5681
(515) 650-3031
(515) 219-4772

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00427241
NC
05
7100785550
KY
Enumeration date
09/29/2023
Last updated
12/09/2024
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