Provider Demographics
NPI:1578523684
Name:KHALID, IMRAN (MD)
Entity Type:Individual
Prefix:
First Name:IMRAN
Middle Name:
Last Name:KHALID
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 1:19156 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48193
Mailing Address - Country:US
Mailing Address - Phone:734-778-1396
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:K-17
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-705-2186
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine