Khalid Abdullah Alfares

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

4301114838 Issued in MI

Practice address

3031 W Grand Blvd FL 8
Detroit, MI 48202-3046

Phone

(313) 916-4988

NPI assigned

May 8, 2018

Last updated

Jul 2, 2021By the provider in NPPES

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 MI2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kalfares722486@direct.hfhs.org

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.

• Henry Ford Health System

  • Community/Retail Pharmacy
  • Plymouth, MI
  • NPI 1942931720
  NPD (past)

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

{
    "created_epoch": "1525737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625184000000",
    "number": "1952890683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 W GRAND BLVD FL 8",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023046",
            "telephone_number": "313-916-4988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3031 W GRAND BLVD FL 8",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023046",
            "telephone_number": "313-916-4988"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22201 Moross Rd Ste 50",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482362166",
            "country_code": "US",
            "telephone_number": "313-343-7774",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALFARES",
        "first_name": "KHALID",
        "middle_name": "ABDULLAH",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-08",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301114838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiara Lakresha Alexander, BCBA
• Toi Alexzandria
• Ebtisam Mohamed Alfaid, M.D.
• Rayan Mohammed Alfallaj, MBBS
• Souad Alfaraj, PMHNP-BC
• Teresa Maria Alfau Hernandez, M.D.
• Hanan Mohamed Omar Alfeggi, MD
• Cristina Laker Alfieri, M.D.
• Lourdes Angeles Alfonso, MD
• Alfonzo Smith LLC

• Student in an Organized Health Care Education/Training Program in Detroit, MI
• Providers in Detroit, MI by specialty
• Student in an Organized Health Care Education/Training Program in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.