Healthcare Provider Details

I. General information

NPI: 1295737831
Provider Name (Legal Business Name): QURESH KHAIRULLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18001 E 10 MILE RD SUITE 1
ROSEVILLE MI
48066-3803
US

IV. Provider business mailing address

45640 SCHOENHERR RD SUITE B
SHELBY TOWNSHIP MI
48315-6033
US

V. Phone/Fax

Practice location:
  • Phone: 586-218-5800
  • Fax: 586-218-5808
Mailing address:
  • Phone: 586-247-4300
  • Fax: 586-532-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberQK056739
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number49070
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: