1316946098 NPI number — MOUNIR B ELKHATIB MD

Table of content: MOUNIR B ELKHATIB MD (NPI 1316946098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316946098 NPI number — MOUNIR B ELKHATIB MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELKHATIB
Provider First Name:
MOUNIR
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316946098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4126 N HOLLAND SYLVANIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43623-3536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-517-6788
Provider Business Mailing Address Fax Number:
419-517-7695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4126 N HOLLAND SYLVANIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43623-3536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-517-6788
Provider Business Practice Location Address Fax Number:
419-517-7695
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35036107 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000141182 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 00221 . This is a "PARAMOUNT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0232206 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0633287 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 110176061 . This is a "RRMC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 04-03080 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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