Provider Demographics
NPI:1720345036
Name:KHORFAN, OMAR (DO)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:KHORFAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 S SAGINAW ST STE 800
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1890
Mailing Address - Country:US
Mailing Address - Phone:810-695-5864
Mailing Address - Fax:810-695-2412
Practice Address - Street 1:8220 S SAGINAW ST STE 800
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439
Practice Address - Country:US
Practice Address - Phone:810-695-5864
Practice Address - Fax:810-695-2412
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022113207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine