Provider Demographics
NPI:1881601938
Name:KHODHER, GHAIDA (MD)
Entity type:Individual
Prefix:
First Name:GHAIDA
Middle Name:
Last Name:KHODHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 CROOKS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3609
Mailing Address - Country:US
Mailing Address - Phone:248-844-1873
Mailing Address - Fax:248-844-0219
Practice Address - Street 1:11111 HALL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5711
Practice Address - Country:US
Practice Address - Phone:586-323-2181
Practice Address - Fax:586-323-2184
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301068771207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106339112OtherBCBSM
MI4193451Medicaid
MI1106339112OtherBCBSM
G83529Medicare UPIN