Healthcare Provider Details

I. General information

NPI: 1285809897
Provider Name (Legal Business Name): BASEL KHATIB, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5728 SCHAEFER RD STE 101
DEARBORN MI
48126-2287
US

IV. Provider business mailing address

5728 SCHAEFER RD STE 101
DEARBORN MI
48126-2287
US

V. Phone/Fax

Practice location:
  • Phone: 313-624-3005
  • Fax: 313-846-4547
Mailing address:
  • Phone: 313-624-3005
  • Fax: 313-846-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBK058311
License Number StateMI

VIII. Authorized Official

Name: DR. BASEL KHATIB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 313-624-3005