| Raid Al-khersan | |
|
17327 Stonebrook Dr Northville MI 48168-4325 | |
| (248) 849-4226 | |
| (248) 849-4240 |
| Full Name | Raid Al-khersan |
|---|---|
| Speciality | Internal Medicine |
| Location | 17327 Stonebrook Dr, Northville, Michigan |
| Authorized Official Name and Position | Raid Al-khersan (OWNER) |
| Authorized Official Contact | 2488494226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Raid Al-khersan 17327 Stonebrook Dr Northville MI 48168-4325 Ph: (248) 849-4226 | Raid Al-khersan 17327 Stonebrook Dr Northville MI 48168-4325 Ph: (248) 849-4226 |
| NPI Number | 1396058442 |
|---|---|
| Provider Enumeration Date | 07/19/2010 |
| Last Update Date | 12/23/2010 |
| Medicare PECOS PAC ID | 0446430656 |
|---|---|
| Medicare Enrollment ID | O20110204000680 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396058442 | NPI | - | NPPES |
| 1134221625 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Secondary |
| Provider Name | Raid Hashim Fadhil Al-khersan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134221625 PECOS PAC ID: 5991793861 Enrollment ID: I20040501000221 |
| Provider Name | Catherine M Evangelista-haugen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649524588 PECOS PAC ID: 1658524327 Enrollment ID: I20130104000489 |
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