Individual
KHALED IMAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3535 W 13 MILE RD, STE. 108, ROYAL OAK, MI 48073-6710
(248) 551-1756
Mailing address
130 TOWN CENTER DR STE 203, TROY, MI 48084-1744
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
4301047866
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110F376980
BCBSM
MI
05
—
2947749
—
MI
Enumeration date
03/22/2006
Last updated
10/21/2020
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