Healthcare Provider Details

I. General information

NPI: 1568535789
Provider Name (Legal Business Name): KHEIR ALZOUHAYLI, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43700 WOODWARD AVE 202
BLOOMFIELD HILLS MI
48302
US

IV. Provider business mailing address

43700 WOODWARD AVE 202
BLOOMFIELD HILLS MI
48302
US

V. Phone/Fax

Practice location:
  • Phone: 248-334-3456
  • Fax:
Mailing address:
  • Phone: 248-334-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberKA062394
License Number StateOH

VIII. Authorized Official

Name: KHEIR ALZOUHAYLI
Title or Position: PRESIDENT
Credential: MD
Phone: 248-334-3456