Provider Demographics
NPI:1518019264
Name:KHAZNEH-KATBI, FUAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FUAD
Middle Name:
Last Name:KHAZNEH-KATBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FUAD
Other - Middle Name:
Other - Last Name:KATBI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48303-0585
Mailing Address - Country:US
Mailing Address - Phone:248-335-8610
Mailing Address - Fax:248-335-5942
Practice Address - Street 1:43252 WOODWARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5044
Practice Address - Country:US
Practice Address - Phone:248-335-8610
Practice Address - Fax:248-335-5942
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFK031332207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093111Medicaid
MIB43351Medicare UPIN
MI1093111Medicaid