Khader Hatem Herzallah, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301112880 Issued in MI

Practice address

1215 E Michigan Ave
Lansing, MI 48912-1811

Phone

(517) 364-1000

NPI assigned

Aug 3, 2017

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1501718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1265956957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "788 SERVICE RD RM B-301",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247013",
            "telephone_number": "517-432-2404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 E MICHIGAN AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121811",
            "telephone_number": "517-364-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "788 Service Rd Rm B-301",
            "address_purpose": "LOCATION",
            "city": "East Lansing",
            "state": "MI",
            "postal_code": "488247013",
            "country_code": "US",
            "telephone_number": "517-432-2404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERZALLAH",
        "first_name": "KHADER",
        "middle_name": "HATEM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-03",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301112880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carl Herring, PSY.D.
• Carolyn Herrington, PHD, RN, NNP-BC, CLC
• Renee L Herrington, RN
• Mindy Jo Hersey, RSW
• Cooper Joseph Herstein, LLBSW
• Jessica Herzfeld, MSW
• Hesham E Gayar, MD, PC (Radiation Oncology Consultants)
• Kaitlyn Marie Hesse
• Christina Hetchler
• Joseph Aaron Scott Hethorn, LLPC

• Internal Medicine Physician in Lansing, MI
• Providers in Lansing, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.