Provider Demographics
NPI:1790857621
Name:KHILANANI, PREM V (MD)
Entity Type:Individual
Prefix:DR
First Name:PREM
Middle Name:V
Last Name:KHILANANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44199 DEQUINDRE RD
Mailing Address - Street 2:STE G10
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085
Mailing Address - Country:US
Mailing Address - Phone:248-964-6111
Mailing Address - Fax:248-964-1464
Practice Address - Street 1:44199 DEQUINDRE RD
Practice Address - Street 2:STE G10
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085
Practice Address - Country:US
Practice Address - Phone:248-964-6111
Practice Address - Fax:248-964-1464
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032860207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1371460Medicaid
MI1371460Medicaid
06342653111Medicare ID - Type Unspecified