Provider Demographics
NPI:1639131394
Name:KHOULI, WAEL (MD)
Entity type:Individual
Prefix:
First Name:WAEL
Middle Name:
Last Name:KHOULI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 W MAGNETIC ST
Mailing Address - Street 2:HOSPITAL MEDICINE
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2700
Mailing Address - Country:US
Mailing Address - Phone:906-225-3080
Mailing Address - Fax:906-225-3832
Practice Address - Street 1:420 W MAGNETIC ST
Practice Address - Street 2:HOSPITAL MEDICINE
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2700
Practice Address - Country:US
Practice Address - Phone:906-225-3080
Practice Address - Fax:906-225-3832
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN47225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH26534Medicare UPIN