Provider Demographics
NPI:1699956938
Name:M M KHOULANI MD PC
Entity type:Organization
Organization Name:M M KHOULANI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:MONIR
Authorized Official - Last Name:KHOULANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-720-5440
Mailing Address - Street 1:5080 VILLA LINDE PKWY
Mailing Address - Street 2:UNIT 4
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3423
Mailing Address - Country:US
Mailing Address - Phone:810-720-5440
Mailing Address - Fax:
Practice Address - Street 1:5080 VILLA LINDE PKWY
Practice Address - Street 2:UNIT 4
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3423
Practice Address - Country:US
Practice Address - Phone:810-720-5440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0250457OtherBCN
MI4136160Medicaid
MI0986522OtherHEALTHPLUS
MI1102504571OtherBCBSM
MIC6999OtherMCARE
MI0986522OtherHEALTHPLUS
MI0P09790Medicare PIN