MEDICARE: KHALED AWWAD PMHNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704330112	MI

General Provider Information

NPI Number	:	1093689192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHALED AWWAD PMHNP

Provider Business Mailing Address
First Line	:	5770 HIGHLAND RD STE A
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-1877
Country	:	US
Telephone Number	:	248-775-7767
Fax Number	:

Provider Business Practice Location Address
First Line	:	5770 HIGHLAND RD STE A
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-1877
Country	:	US
Telephone Number	:	248-775-7767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2025
Last Update Date	:	03/24/2026

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