Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301096493 | MI |
Y | 2084N0402X | Child Neurologist | 4301096493 | MI |
NPI | 1164738043 |
---|---|
Provider Name | Suad Khalil |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48824-7015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2010 |
Last Update Date | 31/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164738043 | (05) | MI |