Provider Demographics
NPI:1750332573
Name:MASRI, KALIL M (DO)
Entity Type:Individual
Prefix:
First Name:KALIL
Middle Name:M
Last Name:MASRI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:401 S. BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1591
Practice Address - Street 1:3175 W. PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2823
Practice Address - Country:US
Practice Address - Phone:989-894-3278
Practice Address - Fax:989-891-8155
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012443207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114603030Medicaid
MIH3500Medicare UPIN