Provider Demographics
NPI:1134908551
Name:KHREIS, ALI
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:KHREIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 ROYAL LYTHAM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6235
Mailing Address - Country:US
Mailing Address - Phone:573-239-9434
Mailing Address - Fax:
Practice Address - Street 1:4800 ROYAL LYTHAM DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6235
Practice Address - Country:US
Practice Address - Phone:573-239-9434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program