Healthcare Provider Details

I. General information

NPI: 1790305399
Provider Name (Legal Business Name): HUSSEIN KHALIL GHARIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19725 ALLEN RD STE 101
BROWNSTOWN TWP MI
48183-1090
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 734-479-2371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301508800
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: