Provider Demographics
NPI:1093821902
Name:KHAZZAM, MICHAEL SAUL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SAUL
Last Name:KHAZZAM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1631 LANCASTER DR STE 230
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3586
Mailing Address - Country:US
Mailing Address - Phone:469-800-7200
Mailing Address - Fax:469-800-7210
Practice Address - Street 1:1631 LANCASTER DR STE 230
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3586
Practice Address - Country:US
Practice Address - Phone:469-800-7200
Practice Address - Fax:469-800-7210
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT2005031078207X00000X
TXN9576207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery