Provider Demographics
NPI:1467520916
Name:KHAIRA, RAVINDER K (MD)
Entity Type:Individual
Prefix:
First Name:RAVINDER
Middle Name:K
Last Name:KHAIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD MEDICAL GROUP - DETROIT NORTHWEST
Mailing Address - Street 2:7800 W OUTER DRIVE
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:313-653-2500
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD MEDICAL GROUP - DETROIT NORTHWEST
Practice Address - Street 2:7800 W OUTER DRIVE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-653-2500
Practice Address - Fax:313-653-2555
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RK047822OtherCOMMERCIAL-COMMERCIAL NUMBER
RK047822OtherCHAMPUS-CHAMPUS
E82665Medicare UPIN