Healthcare Provider Details

I. General information

NPI: 1306236633
Provider Name (Legal Business Name): KASSEM KHREIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 N WELLNESS DR BLDG A
HOLLAND MI
49424-7264
US

IV. Provider business mailing address

3235 N WELLNESS DR BLDG A
HOLLAND MI
49424-7264
US

V. Phone/Fax

Practice location:
  • Phone: 616-399-9522
  • Fax:
Mailing address:
  • Phone: 616-399-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301513664
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301513664
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: