Healthcare Provider Details

I. General information

NPI: 1598009540
Provider Name (Legal Business Name): AMER JAAFAR EL-KHATIB D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21230 DEQUINDRE RD
WARREN MI
48091-2279
US

IV. Provider business mailing address

21230 DEQUINDRE RD
WARREN MI
48091-2279
US

V. Phone/Fax

Practice location:
  • Phone: 586-427-1000
  • Fax:
Mailing address:
  • Phone: 313-443-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: