Mazen Khalidi MD PC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

4301034244 Issued in MI

Legal business name

MAZEN KHALIDI MD PC

Practice address

22790 Harper Ave
Suite C
Saint Clair Shores, MI 48080-1831

Phone

(586) 778-6060

Fax

(586) 773-8220

NPI assigned

Jul 6, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Mazen Khalidi, MD

Title

Owner

Phone

(586) 778-6060

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1215302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215302400000",
    "number": "1295998789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22790 HARPER AVE",
            "address_2": "SUITE C",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801831",
            "telephone_number": "586-778-6060",
            "fax_number": "586-773-8220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22790 HARPER AVE",
            "address_2": "SUITE C",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801831",
            "telephone_number": "586-778-6060",
            "fax_number": "586-773-8220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAZEN KHALIDI MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-06",
        "last_updated": "2008-07-06",
        "status": "A",
        "authorized_official_last_name": "KHALIDI",
        "authorized_official_first_name": "MAZEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-778-6060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301034244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Peter Mastromonaco, MD
• Neethu Mathew, M.D.
• Alma Maurer
• Laura Susan Maurer, LMSW
• Anne Maynard
• Gabriela Mazur, DO
• Cheryl M Mazzara, M.D.
• Patrick M McCabe, M.A., L.L.P.
• Lydia J McCafferty
• Deborah Shawntae McCall

• Surgery Physician in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2008; 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.