Healthcare Provider Details

I. General information

NPI: 1447709662
Provider Name (Legal Business Name): WALEED RHEBI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25523 VAN DYKE AVE
CENTER LINE MI
48015-1824
US

IV. Provider business mailing address

22330 LAWRENCE AVE
DEARBORN MI
48128-1468
US

V. Phone/Fax

Practice location:
  • Phone: 586-757-5454
  • Fax: 586-757-4147
Mailing address:
  • Phone: 267-288-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901022099
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: