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General NPI Number Information
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NPI Number | 1699396549
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Entity Type | Individual
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Provider Name | KHALID MUSTAFA ETEER MD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 1 GENESYS PKWY
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City | GRAND BLANC
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State | MI
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Zip | 48439-8065
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Country | US
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Telephone | 810-606-5359
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Fax | 810-606-6966
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Provider Business Mailing Address
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Address Line | 1 FORD PL STE 3A
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City | DETROIT
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State | MI
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Zip | 48202-3450
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Country | US
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Telephone | 313-874-4806
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2025-00602
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301511962
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 76545
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License Number State | AZ
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