Provider Demographics
NPI:1851347348
Name:KHALIL & USEN DPM, PC
Entity Type:Organization
Organization Name:KHALIL & USEN DPM, PC
Other - Org Name:FAMILY FOOT AND ANKLE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:FAYEZ
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-284-1333
Mailing Address - Street 1:1628 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-2304
Mailing Address - Country:US
Mailing Address - Phone:734-284-1333
Mailing Address - Fax:734-284-1311
Practice Address - Street 1:1628 FORD AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-2304
Practice Address - Country:US
Practice Address - Phone:734-284-1333
Practice Address - Fax:734-284-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H22778OtherBLUE CROSS AND BLUE SHIELD OF MICHIGAN
MIDF5292OtherRAILROAD MEDICARE
MI0P31940Medicare PIN
MI0H22778OtherBLUE CROSS AND BLUE SHIELD OF MICHIGAN
MIV06751Medicare UPIN