MEDICARE: DR. MICHAEL KHALIL M.D.

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	207P00000X	Emergency Medicine Physician	4301101244	MI

General Provider Information

NPI Number	:	1477816346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL KHALIL M.D.

Provider Business Mailing Address
First Line	:	4201 ST ANTOINE
Second Line	:	STE 3R
City	:	DETROIT
State	:	MI
Zip	:	48201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 ST ANTOINE STE 3R
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-1446
Country	:	US
Telephone Number	:	313-420-8630
Fax Number	:

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

Provider Enumeration Date	:	06/16/2012
Last Update Date	:	09/05/2017

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