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General NPI Number Information
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NPI Number | 1649193285
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Entity Type | Organization
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Legal Business Name | VANDUTCH MEDSURG PLLC
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 424 W 5TH ST STE 200
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City | ROYAL OAK
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State | MI
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Zip | 48067-2573
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Country | US
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Telephone | 313-460-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 424 W 5TH ST STE 200
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City | ROYAL OAK
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State | MI
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Zip | 48067-2573
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALI KHAZAAL
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Credential | DPM
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Telephone | 313-460-4443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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