Provider Demographics
NPI:1003852856
Name:KHOULANI, MOHAMAD MONIR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:MONIR
Last Name:KHOULANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 VILLA LINDE PKWY
Mailing Address - Street 2:UNIT 4
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3411
Mailing Address - Country:US
Mailing Address - Phone:810-720-5440
Mailing Address - Fax:810-720-4670
Practice Address - Street 1:5080 VILLA LINDE PKWY
Practice Address - Street 2:UNIT 4
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3411
Practice Address - Country:US
Practice Address - Phone:810-720-5440
Practice Address - Fax:810-720-4670
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMK056414207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0250457OtherBCN
MI4136160Medicaid
MI1102504571OtherBCBSM
MIC6999OtherMCARE
MI0986522OtherHEALTHPLUS
MI900002828OtherMEDICARE RAILROAD CARRIER
MI0P09790Medicare PIN
MI0250457OtherBCN