1568535789 NPI number — KHEIR ALZOUHAYLI, MD

Table of content: DR. SUSAN GARDIN DR.PH, LMHC, LPCC (NPI 1821345034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568535789 NPI number — KHEIR ALZOUHAYLI, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KHEIR ALZOUHAYLI, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1568535789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43700 WOODWARD AVE
Provider Second Line Business Mailing Address:
202
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-334-3456
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43700 WOODWARD AVE
Provider Second Line Business Practice Location Address:
202
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-334-3456
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALZOUHAYLI
Authorized Official First Name:
KHEIR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-334-3456

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  KA062394 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: KA062394 . This is a "STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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