Provider Demographics
NPI:1972780286
Name:KHALIL AND USEN DPM PC II
Entity Type:Organization
Organization Name:KHALIL AND USEN DPM PC II
Other - Org Name:FAMILY FOOT AND ANKLE II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:ALANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:2075 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2191
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:2008-01-29
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001881213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00H23317OtherBLUE CROSS AND BLUE SHIELD OF MICHIGAN
MI0P53390Medicare PIN