Provider Demographics
NPI:1790102697
Name:JEFFREY A. KHABIR, MD, PLLC
Entity Type:Organization
Organization Name:JEFFREY A. KHABIR, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHABIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-953-5330
Mailing Address - Street 1:1985 PARKLAND ST
Mailing Address - Street 2:P.O. BOX 1939
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-6017
Mailing Address - Country:US
Mailing Address - Phone:989-953-5330
Mailing Address - Fax:
Practice Address - Street 1:1985 PARKLAND ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-6017
Practice Address - Country:US
Practice Address - Phone:989-953-5330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047556207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty