Provider Demographics
NPI:1790305399
Name:GHARIB, HUSSEIN KHALIL (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSSEIN
Middle Name:KHALIL
Last Name:GHARIB
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 1:19229 MACK AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2857
Mailing Address - Country:US
Mailing Address - Phone:313-647-3245
Mailing Address - Fax:313-647-3244
Practice Address - Street 1:19229 MACK AVE STE 23
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2857
Practice Address - Country:US
Practice Address - Phone:313-647-3245
Practice Address - Fax:313-647-3244
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351046472207R00000X
MI4301508800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine