Provider Demographics
NPI:1275863102
Name:EL-KHATIB, ANWAR J (PA-C)
Entity Type:Individual
Prefix:DR
First Name:ANWAR
Middle Name:J
Last Name:EL-KHATIB
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7814 THEISEN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1244
Mailing Address - Country:US
Mailing Address - Phone:313-415-1989
Mailing Address - Fax:
Practice Address - Street 1:7814 THEISEN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1244
Practice Address - Country:US
Practice Address - Phone:313-415-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant