Provider Demographics
NPI:1477395135
Name:MOUSA, KHALED ABDULLAH
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:ABDULLAH
Last Name:MOUSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18254 REED ST
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-1523
Mailing Address - Country:US
Mailing Address - Phone:313-587-8283
Mailing Address - Fax:
Practice Address - Street 1:18254 REED ST
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1523
Practice Address - Country:US
Practice Address - Phone:313-587-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program