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General NPI Number Information
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NPI Number | 1730107178
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Entity Type | Individual
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Provider Name | MAHMOOD A KHALID MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 461 W HURON ST
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City | PONTIAC
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State | MI
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Zip | 48341-1601
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Country | US
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Telephone | 248-857-7515
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Fax | 248-857-7524
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Provider Business Mailing Address
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Address Line | PO BOX 77000 DEPT 160901
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City | DETROIT
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State | MI
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Zip | 48277-1609
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Country | US
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Telephone | 248-857-7515
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Fax | 734-677-7407
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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 | 035499
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License Number State | MI
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