1093970451 NPI number — KHALID ZAKARIA MD PC

Table of content: (NPI 1093970451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093970451 NPI number — KHALID ZAKARIA MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KHALID ZAKARIA MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093970451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24333 ORCHARD LAKE RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48336-1976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-477-9800
Provider Business Mailing Address Fax Number:
248-477-9801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24333 ORCHARD LAKE RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48336-1976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-477-9800
Provider Business Practice Location Address Fax Number:
248-477-9801
Provider Enumeration Date:
07/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ZAKARIA
Authorized Official First Name:
KHALID
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-477-9800

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  KZ075860 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0F36397 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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