Provider Demographics
NPI:1821127564
Name:KHALIL, CHARLES M (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:KHALIL
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:22770 KELLY RD
Mailing Address - Street 2:#3
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2009
Mailing Address - Country:US
Mailing Address - Phone:586-447-4900
Mailing Address - Fax:586-447-0024
Practice Address - Street 1:22770 KELLY RD
Practice Address - Street 2:#3
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2009
Practice Address - Country:US
Practice Address - Phone:586-447-4900
Practice Address - Fax:586-447-0024
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MICK001653213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICK001653OtherLICENCE
MI061549240OtherTAX ID #
MI4855050810OtherBLUE CROSS
MI4855050810OtherBLUE CROSS
MIU54375Medicare UPIN