Provider Demographics
NPI:1104661776
Name:KHAIRALSEED, MOHAMEDALMORTDA (MD)
Entity type:Individual
Prefix:MR
First Name:MOHAMEDALMORTDA
Middle Name:
Last Name:KHAIRALSEED
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 1:1861 STONEBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-6229
Mailing Address - Country:US
Mailing Address - Phone:734-209-2143
Mailing Address - Fax:
Practice Address - Street 1:4160 JOHN R ST STE 615
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2022
Practice Address - Country:US
Practice Address - Phone:313-745-4195
Practice Address - Fax:313-993-8669
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program