Provider Demographics
NPI:1437462579
Name:KHAN, MAZHAR HASAN (MD FACC)
Entity type:Individual
Prefix:DR
First Name:MAZHAR
Middle Name:HASAN
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:22720 MICHIGAN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2021
Mailing Address - Country:US
Mailing Address - Phone:313-791-3000
Mailing Address - Fax:313-791-2800
Practice Address - Street 1:4160 JOHN R ST STE 510
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2021
Practice Address - Country:US
Practice Address - Phone:313-993-7777
Practice Address - Fax:313-791-2800
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301100515207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630791Medicare PIN