Individual provider Active NPI

Leila Khanji

  • Family Nurse Practitioner
  • Dearborn, MI
National Provider Identifier
1679319909
Registry record updated Jul 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704371568 Issued in MI
Practice address
660 S Waverly St
Dearborn, MI 48124-1652
Phone
(313) 244-4449
NPI assigned
Jul 5, 2024
Last updated
Jul 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704371568 MI Primary

Addresses

Primary practice location

660 S Waverly St
Dearborn, MI 48124-1652

Mailing address

660 S Waverly St
Dearborn, MI 48124-1652

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260528002381 MI Practitioner - Nurse Practitioner 5799255931 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1678 S Merriman Rd
Westland, MI 48186-5355

99 Rochester Ave
East Atlantic Beach, NY 11561-1032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704371568MIMDFamily Nurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1720137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1679319909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S WAVERLY ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 S WAVERLY ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241652",
            "telephone_number": "313-244-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANJI",
        "first_name": "LEILA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-05",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704371568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.