Provider Demographics
NPI:1427430487
Name:KHALIFA, SALLY (DO)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:KHALIFA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22350 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2421
Mailing Address - Country:US
Mailing Address - Phone:313-406-2410
Mailing Address - Fax:
Practice Address - Street 1:22350 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2421
Practice Address - Country:US
Practice Address - Phone:313-406-2410
Practice Address - Fax:313-406-6484
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine