Healthcare Provider Details

I. General information

NPI: 1821900374
Provider Name (Legal Business Name): MOUSTAFA ALI KHALIL LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 W LIBERTY RD
ANN ARBOR MI
48103-9746
US

IV. Provider business mailing address

2200 N CANTON CENTER RD STE 200A
CANTON MI
48187-5038
US

V. Phone/Fax

Practice location:
  • Phone: 734-559-3540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: