Provider Demographics
NPI:1578206041
Name:HARMOUCH, KHALED (MD)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:HARMOUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N
Mailing Address - Street 2:40TH ST. APT: 15
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131
Mailing Address - Country:US
Mailing Address - Phone:346-448-7949
Mailing Address - Fax:
Practice Address - Street 1:6071 WEST OUTER DRIVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-966-7437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program