Organization
DOWNRIVER CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOUNIR KHALED MD (OWNER MEDICAL DIRECTOR PHYSICIAN)
(734) 675-0705
Entity
Organization
Contact information
Practice address
8944 MACOMB ST, GROSSE ILE, MI 48138-2089
(734) 675-0705
(734) 675-0747
Mailing address
8944 MACOMB ST, GROSSE ILE, MI 48138-2089
(734) 675-0705
(734) 675-0747
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301091157
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110H242960
BCBS GROUP
MI
05
—
1205073285
—
MI
01
—
174382
GREAT LAKES
MI
01
—
259686
DEPT OF LABOR STATE
MI
01
—
614738100
DEPT OF LABOR
MI
01
—
82028050
PROCARE
MI
01
—
DO7341
RAILROAD MEDICARE
MI
Enumeration date
01/14/2009
Last updated
07/15/2010
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