Provider Demographics
NPI:1366671521
Name:MURAD-KEJBOU, SALLY JAMAL (DO)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:JAMAL
Last Name:MURAD-KEJBOU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43700 WOODWARD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5058
Mailing Address - Country:US
Mailing Address - Phone:248-550-0393
Mailing Address - Fax:
Practice Address - Street 1:43700 WOODWARD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5058
Practice Address - Country:US
Practice Address - Phone:248-550-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018290207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology