1821016262 NPI number — ADEEL KHALID M.D.

Table of content: ADEEL KHALID M.D. (NPI 1821016262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821016262 NPI number — ADEEL KHALID M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHALID
Provider First Name:
ADEEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1821016262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67000
Provider Second Line Business Mailing Address:
DEPT 160901
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48267-1609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-493-8098
Provider Business Mailing Address Fax Number:
734-677-7407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
461 WEST HURON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONTIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48341-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-857-7515
Provider Business Practice Location Address Fax Number:
734-677-7407
Provider Enumeration Date:
07/17/2006

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: 2085R0202X , with the licence number:  068657 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 4301068657 , 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: CI8050 . This is a "MEDICARE RR GROUP PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0E01133 . This is a "BCBS GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4274881 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4636536 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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