Basic Information
| Provider Information | |||||||||
| NPI: | 1891216834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHALIL | ||||||||
| FirstName: | AHMAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | CEDAR PEDIATRICS, 5303 S. CEDAR ST | ||||||||
| Address2: | SUITE 205, PO BOX 30161 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178874305 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 MICHIGAN ST NE STE 4200 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162679150 | ||||||||
| FaxNumber: | 6162671408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2017 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | 4301502625 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 208000000X | 4301502625 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 4301113336 | 01 | MI | MEDICAL LICENSE | OTHER |