Healthcare Provider Details

I. General information

NPI: 1134573181
Provider Name (Legal Business Name): MAHMOUD KHAIRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. MAHMOUD MOHAMED ALASHRY

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-1000
  • Fax:
Mailing address:
  • Phone: 517-364-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4351050965
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: