Provider Demographics
NPI:1174055958
Name:KHORFAN, KAMAL (MD)
Entity type:Individual
Prefix:
First Name:KAMAL
Middle Name:
Last Name:KHORFAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 N SHIAWASSEE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1632
Mailing Address - Country:US
Mailing Address - Phone:989-729-1600
Mailing Address - Fax:989-729-4070
Practice Address - Street 1:721 N SHIAWASSEE ST STE 202
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1632
Practice Address - Country:US
Practice Address - Phone:989-729-1600
Practice Address - Fax:989-729-4070
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA169880207RG0100X
MI4301509454207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1174055958Medicaid