Provider Demographics
NPI:1861982175
Name:KHASHOLA, ANTHONY MUKHLIS (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MUKHLIS
Last Name:KHASHOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:51221 SCHOENHERR RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2718
Mailing Address - Country:US
Mailing Address - Phone:586-323-4450
Mailing Address - Fax:586-323-4448
Practice Address - Street 1:51221 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-2708
Practice Address - Country:US
Practice Address - Phone:586-263-2300
Practice Address - Fax:586-323-4448
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301504457207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine