Provider Demographics
NPI:1144478520
Name:KHALIL, AIDA J (MD)
Entity type:Individual
Prefix:DR
First Name:AIDA
Middle Name:J
Last Name:KHALIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17200 E 10 MILE RD STE 230
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3300
Mailing Address - Country:US
Mailing Address - Phone:586-445-7900
Mailing Address - Fax:586-445-7903
Practice Address - Street 1:17200 E 10 MILE RD STE 230
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3300
Practice Address - Country:US
Practice Address - Phone:586-445-7900
Practice Address - Fax:586-445-7903
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301036063208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF27397Medicare UPIN
MI0631899Medicare PIN