Provider Demographics
NPI:1649440165
Name:JOWHER KHALEEL MD PC
Entity type:Organization
Organization Name:JOWHER KHALEEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOWHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-474-1144
Mailing Address - Street 1:20000 FARMINGTON RD
Mailing Address - Street 2:BLDG E
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1408
Mailing Address - Country:US
Mailing Address - Phone:248-474-1144
Mailing Address - Fax:248-474-1548
Practice Address - Street 1:20000 FARMINGTON RD
Practice Address - Street 2:BLDG E
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1408
Practice Address - Country:US
Practice Address - Phone:248-474-1144
Practice Address - Fax:248-474-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJK047784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2575509Medicaid
MI2575509Medicaid
B43254Medicare UPIN