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: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SCHAEFER RD STE 260
DEARBORN MI
48126-3743
US

IV. Provider business mailing address

4700 SCHAEFER RD STE 260
DEARBORN MI
48126-3743
US

V. Phone/Fax

Practice location:
  • Phone: 947-523-4650
  • Fax: 313-943-2914
Mailing address:
  • Phone: 947-523-4650
  • Fax: 313-943-2914

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: