Individual
MUMTAZ J. KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 15401 EAST JEFFERSON, GROSSE POINTE PARK, MI 48230
(313) 824-4800
(313) 824-7080
Mailing address
HENRY FORD HEALTH SYSTEM, 15401 EAST JEFFERSON, GROSSE POINTE PARK, MI 48230
(313) 824-4800
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
4301065423
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
434035010
—
MI
01
—
700H262260
BLUE CROSS-BLUE CROSS
—
01
—
MK065423
CHAMPUS-CHAMPUS
—
Enumeration date
11/29/2006
Last updated
07/08/2007
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