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General NPI Number Information
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NPI Number | 1619923455
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Entity Type | Individual
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Provider Name | KHALIL M NASRALLAH MD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 2799 W GRAND BOULEVARD NULL
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City | DETROIT
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State | MI
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Zip | 48267-9622
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Country | US
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Telephone | 313-916-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2837 US 41 WEST
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City | MARQUETTE
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State | MI
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Zip | 49855-0220
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Country | US
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Telephone | 906-225-3964
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Fax | 906-226-3875
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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 | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 4301079672
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number | 4301079672
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301079672
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License Number State | MI
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