Provider Demographics
NPI:1649665324
Name:AL-OBAIDY, KHALEEL IBRAHIM (MD)
Entity type:Individual
Prefix:DR
First Name:KHALEEL
Middle Name:IBRAHIM
Last Name:AL-OBAIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KHALEEL
Other - Middle Name:IBRAHIM
Other - Last Name:AL-OBAIDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:335 W 9TH ST UNIT 323
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3125
Mailing Address - Country:US
Mailing Address - Phone:313-898-1673
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:800-653-6568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN11019155A390200000X
MI4301505859207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty