Healthcare Provider Details

I. General information

NPI: 1669100541
Provider Name (Legal Business Name): NOOR KHALIL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 INKSTER RD
GARDEN CITY MI
48135-4001
US

IV. Provider business mailing address

27372 MICHELE ST
DEARBORN HEIGHTS MI
48127-1809
US

V. Phone/Fax

Practice location:
  • Phone: 734-458-3300
  • Fax:
Mailing address:
  • Phone: 313-721-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704349552
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: