Provider Demographics
NPI:1265591507
Name:JAFFERY-KHALIL, SHEHLA (MD)
Entity type:Individual
Prefix:
First Name:SHEHLA
Middle Name:
Last Name:JAFFERY-KHALIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHEHLA
Other - Middle Name:T
Other - Last Name:JAFFERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:2825 LIVERNOIS
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-680-6000
Mailing Address - Fax:248-680-6068
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:2825 LIVERNOIS
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-680-6000
Practice Address - Fax:248-680-6068
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057909208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI343409610Medicaid
700H262220OtherBLUE CROSS-BLUE CROSS
SJ057909OtherCOMMERCIAL-COMMERCIAL NUMBER
SJ057909OtherCHAMPUS-CHAMPUS
700H262220OtherBLUE CROSS-BLUE CROSS
SJ057909OtherCOMMERCIAL-COMMERCIAL NUMBER