Healthcare Provider Details

I. General information

NPI: 1003852856
Provider Name (Legal Business Name): MOHAMAD MONIR KHOULANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 VILLA LINDE PKWY UNIT 4
FLINT MI
48532-3411
US

IV. Provider business mailing address

5080 VILLA LINDE PKWY UNIT 4
FLINT MI
48532-3411
US

V. Phone/Fax

Practice location:
  • Phone: 810-720-5440
  • Fax: 810-720-4670
Mailing address:
  • Phone: 810-720-5440
  • Fax: 810-720-4670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMK056414
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: