Provider Demographics
NPI:1023372257
Name:KHALIL, AMAL ALI (DO)
Entity Type:Individual
Prefix:DR
First Name:AMAL
Middle Name:ALI
Last Name:KHALIL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:AMAL
Other - Middle Name:
Other - Last Name:RAYCHOUNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9340 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3362
Mailing Address - Country:US
Mailing Address - Phone:313-295-3388
Mailing Address - Fax:313-295-4198
Practice Address - Street 1:9340 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3362
Practice Address - Country:US
Practice Address - Phone:313-295-3388
Practice Address - Fax:313-295-4198
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine