Khaled Kudsi, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5151014829 Issued in MI

Practice address

44250 Dequindre Rd
Sterling Heights, MI 48314-1002

Phone

(248) 964-0400

Fax

(248) 964-0521

NPI assigned

Apr 15, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1033790696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44250 DEQUINDRE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141002",
            "telephone_number": "248-964-0400",
            "fax_number": "248-964-0521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44250 DEQUINDRE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141002",
            "telephone_number": "248-964-0400",
            "fax_number": "248-964-0521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDSI",
        "first_name": "KHALED",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-15",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5151014829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krystal Clear Counseling PLLC
• Lauren Victoria Krywy
• Patricia S Kubany, OT
• Donald James Kubicki, DDS
• Sudha Kudapa
• Sierra Kudsin, LMSW
• Noah Christopher Lee Kueber, DPT
• Krystal Kuehn, LPC
• Shirlee E. Kuhl, D.O.
• Katherine Kuhn

• Family Medicine Physician in Sterling Heights, MI
• Providers in Sterling Heights, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.