Provider Demographics
NPI:1578619953
Name:HARB, SHEHADEH KHALIL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEHADEH
Middle Name:KHALIL
Last Name:HARB
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 1:21430 HCL JACKSON
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1192
Mailing Address - Country:US
Mailing Address - Phone:734-692-0772
Mailing Address - Fax:734-692-0772
Practice Address - Street 1:2333 BIDDLE ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4668
Practice Address - Country:US
Practice Address - Phone:734-324-3616
Practice Address - Fax:734-324-3615
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075365208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104511233Medicaid
MI104511233Medicaid
MI83785Medicare UPIN