MEDICARE: DR. RAMI KHALIL DDS

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	1223G0001X	General Practice Dentistry	2901022252	MI

General Provider Information

NPI Number	:	1548787997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMI KHALIL DDS

Provider Business Mailing Address
First Line	:	1074 JACKSON XING
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-2039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1074 JACKSON XING
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-2039
Country	:	US
Telephone Number	:	517-841-0000
Fax Number	:

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

Provider Enumeration Date	:	08/26/2017
Last Update Date	:	09/25/2019

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