| |
2560 Lynwood Dr Ste 3 Troy MI 48083-5681 | |
(515) 650-3031 | |
Not Available |
Full Name | |
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Speciality | Internal Medicine |
Location | 2560 Lynwood Dr Ste 3, Troy, Michigan |
Authorized Official Name and Position | Hassan Khan (MEDICAL DIRECTOR) |
Authorized Official Contact | 5156503031 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2560 Lynwood Dr Troy MI 48083-5681 Ph: (515) 650-3031 | 2560 Lynwood Dr Ste 3 Troy MI 48083-5681 Ph: (515) 650-3031 |
NPI Number | 1174303077 |
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Provider Enumeration Date | 09/29/2023 |
Last Update Date | 12/09/2024 |
Medicare PECOS PAC ID | 6608222369 |
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Medicare Enrollment ID | O20231101000994 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174303077 | NPI | - | NPPES |
00427241 | Medicaid | NC | |
7100785550 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Hassan Ali Khan |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1033631858 PECOS PAC ID: 2769739465 Enrollment ID: I20220118001233 |
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