Healthcare Provider Details

I. General information

NPI: 1487854022
Provider Name (Legal Business Name): MOHAMED ABDELRAHMAN A KHEDR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 S LINDEN RD SUITE # C
FLINT MI
48532-3420
US

IV. Provider business mailing address

1335 S LINDEN RD SUITE # C
FLINT MI
48532-3420
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-0010
  • Fax: 810-733-0011
Mailing address:
  • Phone: 810-733-0010
  • Fax: 810-733-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301083799
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: