Healthcare Provider Details

I. General information

NPI: 1659938785
Provider Name (Legal Business Name): SURAYA KHALED NAHLAWI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR # B1D502
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

16001 W 9 MILE RD STE 416
SOUTHFIELD MI
48075-4818
US

V. Phone/Fax

Practice location:
  • Phone: 734-615-9016
  • Fax:
Mailing address:
  • Phone: 248-849-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5151013758
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5101027784
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDO4176
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38585
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: