Individual
KHA NGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
26850 PROVIDENCE PKWY, SUITE 350, NOVI, MI 48374-1213
(248) 662-4110
(248) 662-4120
Mailing address
26850 PROVIDENCE PKWY, SUITE 350, NOVI, MI 48374-1213
(248) 662-4110
(248) 662-4120
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101017406
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01336330
HEALTH PLUS OF MI
MI
01
—
020F338090
BLUE CROSS BLUE SHIELD MI
MI
01
—
1336330224
PRIORITY HEALTH
MI
01
—
1336330224
HEALTH ALLIANCE PLAN (HAP)
—
05
—
1336330224
—
MI
01
—
4307482
CIGNA
MI
01
—
5632805
BLUE CARE NETWORK
MI
Enumeration date
08/06/2007
Last updated
09/22/2014
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