Provider Demographics
NPI:1831163377
Name:EL-HOSHY, KHALED HASSAN (MD)
Entity type:Individual
Prefix:DR
First Name:KHALED
Middle Name:HASSAN
Last Name:EL-HOSHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14555 LEVAN RD
Mailing Address - Street 2:STE 410
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5085
Mailing Address - Country:US
Mailing Address - Phone:734-462-9499
Mailing Address - Fax:734-462-4124
Practice Address - Street 1:14555 LEVAN RD
Practice Address - Street 2:STE 410
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5085
Practice Address - Country:US
Practice Address - Phone:734-462-9499
Practice Address - Fax:734-462-4124
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.171576207N00000X
MI4301061513207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI070H201340OtherBLUE CROSS BLUE SHIELD
MI125731OtherPREFERRED CHOICES
MIOP12350002Medicare ID - Type Unspecified