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NPI Code Detail

MEDICARE: TALAL R KHAIRI MD

MEDICARE: TALAL R KHAIRI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology Physician64355WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043471436
Entity Type Code : Individual
Provider Name (Legal Business Name) : TALAL R KHAIRI MD
Provider Business Mailing Address
First Line : 5650 N GREEN BAY AVE STE 210
Second Line :
City : GLENDALE
State : WI
Zip : 53209-4447
Country : US
Telephone Number : 414-431-5971
Fax Number : 414-434-0354
Provider Business Practice Location Address
First Line : 5650 N GREEN BAY AVE STE 210
Second Line :
City : GLENDALE
State : WI
Zip : 53209-4447
Country : US
Telephone Number : 414-431-5971
Fax Number : 414-434-0354
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2008
Last Update Date : 12/17/2021

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Directions to “ TALAL R KHAIRI MD” Practice Location

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