MEDICARE: KHALLED ISMAIL

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	1041C0700X	Clinical Social Worker	6851121127	MI

General Provider Information

NPI Number	:	1386502656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHALLED ISMAIL

Provider Business Mailing Address
First Line	:	14350 TIREMAN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-6100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14350 TIREMAN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-6100
Country	:	US
Telephone Number	:	313-584-4143
Fax Number	:

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ KHALLED ISMAIL ” Practice Location

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