Provider Demographics
NPI:1881702892
Name:KHAN, ASHRAF I (DO)
Entity type:Individual
Prefix:
First Name:ASHRAF
Middle Name:I
Last Name:KHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 LAKE LANSING RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3798
Mailing Address - Country:US
Mailing Address - Phone:517-485-0001
Mailing Address - Fax:517-485-1138
Practice Address - Street 1:5625 WATER TOWER PL
Practice Address - Street 2:SUITE 220
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2671
Practice Address - Country:US
Practice Address - Phone:248-620-4265
Practice Address - Fax:248-620-4262
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIAK011353208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3326123Medicaid
MI0556302985OtherBLUE CROSS BLUE SHIELD
MIP14650001Medicare ID - Type Unspecified
MI0556302985OtherBLUE CROSS BLUE SHIELD