Provider Demographics
NPI:1487644688
Name:KARADSHEH, KHALIL M (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:M
Last Name:KARADSHEH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:30701 WOODWARD AVE
Mailing Address - Street 2:STE S401
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0987
Mailing Address - Country:US
Mailing Address - Phone:248-435-4462
Mailing Address - Fax:248-435-4094
Practice Address - Street 1:30701 WOODWARD AVE
Practice Address - Street 2:STE S401
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0987
Practice Address - Country:US
Practice Address - Phone:248-435-4462
Practice Address - Fax:248-435-4094
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2010-01-17
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Provider Licenses
StateLicense IDTaxonomies
MI4301036025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1356428Medicaid
B44841Medicare UPIN
MI1356428Medicaid
0639192Medicare ID - Type Unspecified