Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | KA062394 | OH |
Y | 2084N0402X | Child Neurologist | KA062394 | MI |
NPI | 1275607533 |
---|---|
Provider Name | Kheir Al-Zouhayli |
First Address | Troy, MI 48083 |
Second Address | Troy, MI 48083-2053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 19/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
KA062394 | STATE LICENSE (01) | MI |