Provider Demographics
NPI:1669449096
Name:KAYALI, FIKRAT BARBOUR (MD)
Entity Type:Individual
Prefix:DR
First Name:FIKRAT
Middle Name:BARBOUR
Last Name:KAYALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13841 BARCLAY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3501
Mailing Address - Country:US
Mailing Address - Phone:313-414-4012
Mailing Address - Fax:
Practice Address - Street 1:10326 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1659
Practice Address - Country:US
Practice Address - Phone:313-581-2064
Practice Address - Fax:313-581-3590
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036984174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3523561Medicaid