Provider Demographics
NPI:1487854022
Name:KHEDR, MOHAMED ABDELRAHMAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:ABDELRAHMAN A
Last Name:KHEDR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1335 S LINDEN RD
Mailing Address - Street 2:SUITE # C
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3420
Mailing Address - Country:US
Mailing Address - Phone:810-733-0010
Mailing Address - Fax:810-733-0011
Practice Address - Street 1:1335 S LINDEN RD
Practice Address - Street 2:SUITE # C
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3420
Practice Address - Country:US
Practice Address - Phone:810-733-0010
Practice Address - Fax:810-733-0011
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301083799207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1602514012OtherBLUE CROSS BLUE SHIELD OF MICHIGAN - PROVIDER ID
MIOB56025OtherBLUE CROSS BLUE SHIELD OF MICHIGAN - GROUP
MIOB56025Medicare PIN