Provider Demographics
NPI:1831539758
Name:KHALIL FAMILY FOOT CARE LLC
Entity type:Organization
Organization Name:KHALIL FAMILY FOOT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-447-4900
Mailing Address - Street 1:22770 KELLY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2009
Mailing Address - Country:US
Mailing Address - Phone:586-447-4900
Mailing Address - Fax:
Practice Address - Street 1:22770 KELLY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2009
Practice Address - Country:US
Practice Address - Phone:586-447-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001653213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty