Provider Demographics
NPI:1346254604
Name:KAZAN, KALLIL IBRAHIM (DC)
Entity Type:Individual
Prefix:DR
First Name:KALLIL
Middle Name:IBRAHIM
Last Name:KAZAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-0414
Mailing Address - Country:US
Mailing Address - Phone:313-477-3305
Mailing Address - Fax:
Practice Address - Street 1:15841 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3737
Practice Address - Country:US
Practice Address - Phone:313-581-6830
Practice Address - Fax:313-216-1741
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor