Shadi Rady Khillah, DDS
Dentist in Galesburg, MI. Individual provider (NPI-1).
NPI number1124433396
StatusActive
Last updated in NPPESApr 17, 2017
Details
- NPI
- 1124433396
- Entity type
- Individual (NPI-1)
- Name
- Shadi Rady Khillah
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 26, 2014
- Last updated
- Apr 17, 2017
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · ORDER AND REFERRING ONLY - DENTIST
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 2901021326 | MI | Yes |
Practice location
357 E Michigan AveGalesburg, MI 49053-9763
Phone 269-665-9997 · Fax 269-665-5088
Mailing address
357 E Michigan AveGalesburg, MI 49053-9763
Phone 269-665-9997 · Fax 269-665-5088
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