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General NPI Number Information
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NPI Number | 1164460481
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Entity Type | Individual
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Provider Name | MOHAMMAD FAYEZ KHALIL DPM
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 20905 GREENFIELD RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5360
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Country | US
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Telephone | 248-423-4220
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Fax | 248-423-4221
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Provider Business Mailing Address
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Address Line | 1628 FORD AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-2304
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Country | US
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Telephone | 734-284-1333
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Fax | 734-284-1311
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901002133
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License Number State | MI
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