Healthcare Provider Details

I. General information

NPI: 1508595539
Provider Name (Legal Business Name): AZEEM KHATRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 3RD ST
BELLEVILLE MI
48111-2605
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 734-697-9065
  • Fax: 734-697-9049
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301514203
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: