Provider Demographics
NPI:1932178936
Name:KHANDWALA, SALIL S (MD)
Entity Type:Individual
Prefix:
First Name:SALIL
Middle Name:S
Last Name:KHANDWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22731 NEWMAN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-982-0200
Mailing Address - Fax:313-982-0500
Practice Address - Street 1:22731 NEWMAN ST STE 200
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2023
Practice Address - Country:US
Practice Address - Phone:313-982-0200
Practice Address - Fax:313-982-0500
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301080830207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00318801OtherRAILROAD MEDICARE
MI14370OtherMCARE
MI0825575OtherBCBSM
MI4851235Medicaid
MI7092103OtherAETNA
MIG62090OtherHAP
MI4851235Medicaid
MIP00318801OtherRAILROAD MEDICARE