Provider Demographics
NPI:1821016262
Name:KHALID, ADEEL (MD)
Entity Type:Individual
Prefix:
First Name:ADEEL
Middle Name:
Last Name:KHALID
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:PO BOX 67000
Mailing Address - Street 2:DEPT 160901
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-1609
Mailing Address - Country:US
Mailing Address - Phone:586-493-8098
Mailing Address - Fax:734-677-7407
Practice Address - Street 1:461 WEST HURON
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1651
Practice Address - Country:US
Practice Address - Phone:248-857-7515
Practice Address - Fax:734-677-7407
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0686572085R0202X
MI43010686572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICI8050OtherMEDICARE RR GROUP PIN
MI0E01133OtherBCBS GROUP
MI4274881Medicaid
MI4636536Medicaid
MIF34966009Medicare ID - Type Unspecified
MIN96750003Medicare ID - Type Unspecified
MI4636536Medicaid
MI0M74500Medicare PIN