Provider Demographics
NPI:1235178112
Name:KRAYEM, HICHAM KHALIL (MD)
Entity Type:Individual
Prefix:
First Name:HICHAM
Middle Name:KHALIL
Last Name:KRAYEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6071 W OUTER DR
Mailing Address - Street 2:SINAI-GRACE HOSPITAL, PULMONARY MEDICINE, SUITE M444
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2624
Mailing Address - Country:US
Mailing Address - Phone:313-966-3075
Mailing Address - Fax:313-966-4498
Practice Address - Street 1:6071 W OUTER DR
Practice Address - Street 2:SINAI-GRACE HOSPITAL, PULMONARY MEDICINE, SUITE M444
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2624
Practice Address - Country:US
Practice Address - Phone:313-966-3075
Practice Address - Fax:313-966-4498
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074293207R00000X, 207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1235178112Medicaid
MIOQ26270Medicare UPIN
DEI-41402Medicare UPIN