NPI 1467294645 · live from the CMS NPI Registry
Khalil Abu-Jubara, DPM
Podiatrist, Primary Podiatric Medicine in Clinton Township, MI. National Provider Identifier 1467294645, active.
NPI record
| NPI | 1467294645 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Podiatrist, Primary Podiatric Medicine 213EP1101X |
| Practice location | 36500 S Gratiot Ave Ste 202, Clinton Township, MI 48035 |
| Practice phone | 586-790-9003 |
| Mailing address | 1000 Harrington St, Mount Clemens, MI 48043 |
| Enumerated | June 10, 2024 |
| Last updated | June 10, 2024 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Podiatrist, Primary Podiatric Medicine primary | 213EP1101X | 5951001525 (MI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.