Provider Demographics
NPI:1538704218
Name:WEST PARK MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:WEST PARK MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:313-438-0198
Mailing Address - Street 1:16238 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3701
Mailing Address - Country:US
Mailing Address - Phone:313-438-0198
Mailing Address - Fax:313-438-0157
Practice Address - Street 1:16238 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3701
Practice Address - Country:US
Practice Address - Phone:313-438-0198
Practice Address - Fax:313-438-0157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-17
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care