Healthcare Provider Details

I. General information

NPI: 1790146009
Provider Name (Legal Business Name): AMAL ALI KHALIFE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MICHIGAN ST NE STE 230
GRAND RAPIDS MI
49503-2550
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-2822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number5151010960
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: