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General NPI Number Information
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NPI Number | 1578678140
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Entity Type | Organization
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Legal Business Name | DR KHALIFA REDA PLLC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 950 N CASS LAKE RD SUITE 112
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City | WATERFORD
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State | MI
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Zip | 48328-2370
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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 | 1579 N JOHN DALY RD
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-4906
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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 | OWNER
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Name | REDA KHALIFA
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Credential | M.D.
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Telephone | 248-683-8050
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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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