Provider Demographics
NPI:1609035179
Name:KHALIL AND USEN DPM PC
Entity Type:Organization
Organization Name:KHALIL AND USEN DPM PC
Other - Org Name:FAMILY FOOT AND ANKLE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-284-1333
Mailing Address - Street 1:1628 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-2304
Mailing Address - Country:US
Mailing Address - Phone:734-284-1333
Mailing Address - Fax:734-284-1311
Practice Address - Street 1:2075 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2191
Practice Address - Country:US
Practice Address - Phone:313-388-2500
Practice Address - Fax:313-388-1366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty