Provider Demographics
NPI:1134618788
Name:KASMIKHA, MARVIN KHALID (DO)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:KHALID
Last Name:KASMIKHA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:MARVIN
Other - Middle Name:KHALID
Other - Last Name:YOUSIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:248-723-5880
Mailing Address - Fax:
Practice Address - Street 1:6900 ORCHARD LAKE RD STE 101
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3424
Practice Address - Country:US
Practice Address - Phone:248-855-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101026164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine