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General NPI Number Information
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NPI Number | 1396787586
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Entity Type | Individual
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Provider Name | REDA A KHALIFA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 3675 HIGHLAND RD SUITE 112
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City | WATERFORD
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State | MI
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Zip | 48328-2326
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Country | US
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Telephone | 248-683-8050
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Fax | 248-683-8590
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Provider Business Mailing Address
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Address Line | 1268 LAKE CRESCENT DR
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-2814
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Country | US
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Telephone | 248-683-8050
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Fax | 248-683-8590
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | RK072714
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License Number State | MI
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