Provider Demographics
NPI:1730354994
Name:KHEIR AL ZOUHAYLI MD PC
Entity type:Organization
Organization Name:KHEIR AL ZOUHAYLI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHEIR
Authorized Official - Middle Name:M
Authorized Official - Last Name:AL ZOUHAYLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-720-2470
Mailing Address - Street 1:1639 E BIG BEAVER
Mailing Address - Street 2:104
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-720-2470
Mailing Address - Fax:248-720-2471
Practice Address - Street 1:1639 E BIG BEAVER
Practice Address - Street 2:104
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-720-2470
Practice Address - Fax:248-720-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKA0623942080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID NUMBER