Provider Demographics
NPI:1992763940
Name:KHATER, MONA (MD)
Entity type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:KHATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13951 PLUMBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1727
Mailing Address - Country:US
Mailing Address - Phone:586-264-0670
Mailing Address - Fax:586-264-2721
Practice Address - Street 1:13951 PLUMBROOK RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1727
Practice Address - Country:US
Practice Address - Phone:586-264-0670
Practice Address - Fax:586-264-2721
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMK059589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4997525Medicaid
MI383494637OtherTAX ID
MI4848786Medicaid
MI0501840OtherBCBS PIN
MI700E012740OtherBCBS GROUP NUMBER
MIP00324647OtherRAILROAD MEDICARE PTAN
MI0501840OtherBCBS PIN
MIP30550001Medicare PIN
MIN40170102Medicare PIN
MIG16849Medicare UPIN
MI4848786Medicaid