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1730570078 NPI number — LAURA MARIE KHALIL C.AD.

NPI Number: 1730570078
Health Care Provider/Practitioner: LAURA MARIE KHALIL C.AD.

Information about “1730570078” NPI (LAURA MARIE KHALIL C.AD.) exists in 1730570078 in HTML format HTML  |  1730570078 in plain Text format TXT  |  1730570078 in PDF (Portable Document Format) PDF  |  1730570078 in an XML format XML  formats.

NPI Number : 1730570078 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730570078",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KHALIL",
    "FirstName": "LAURA",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "C.AD.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "22790 KELLY RD",
    "SecondLineMailingAddress": "SUITE A",
    "MailingAddressCityName": "EASTPOINTE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48021-2019",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "586-771-7600",
    "MailingAddressFaxNumber": "586-771-7617",
    "FirstLinePracticeLocationAddress": "22790 KELLY RD",
    "SecondLinePracticeLocationAddress": "SUITE A",
    "PracticeLocationAddressCityName": "EASTPOINTE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48021-2019",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "586-771-7600",
    "PracticeLocationAddressFaxNumber": "586-771-7617",
    "EnumerationDate": "02/09/2015",
    "LastUpdateDate": "07/03/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QR0405X",
        "TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
        "LicenseNumber": "SA0500442",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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