1093824351 NPI number — DR. KHALED S EL-GANAINY DC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093824351 NPI number — DR. KHALED S EL-GANAINY DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EL-GANAINY
Provider First Name:
KHALED
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093824351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 S CENTER RD
Provider Second Line Business Mailing Address:
BUILDING A
Provider Business Mailing Address City Name:
BURTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48509-1731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-715-7746
Provider Business Mailing Address Fax Number:
810-715-7716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 S CENTER RD
Provider Second Line Business Practice Location Address:
BUILDING A
Provider Business Practice Location Address City Name:
BURTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48509-1731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-715-7746
Provider Business Practice Location Address Fax Number:
810-715-7716
Provider Enumeration Date:
08/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301007889 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 950B513520 . This is a "BCBSM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4619068 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 134211491 . This is a "COMMERICAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1903824351 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".