1700867959 NPI number — AMIN YOUSSEF KHALIL M.D.

Table of content: KATIE BARABAS (NPI 1851033484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700867959 NPI number — AMIN YOUSSEF KHALIL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHALIL
Provider First Name:
AMIN
Provider Middle Name:
YOUSSEF
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KHALIL
Provider Other First Name:
JOSEPH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1700867959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
855 W MAPLE ST
Provider Second Line Business Mailing Address:
HARTVILLE
Provider Business Mailing Address City Name:
HARTVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44632-9668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-877-9388
Provider Business Mailing Address Fax Number:
330-488-2907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 W MAPLE ST
Provider Second Line Business Practice Location Address:
HARTVILLE
Provider Business Practice Location Address City Name:
HARTVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44632-9668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-877-9388
Provider Business Practice Location Address Fax Number:
330-488-2907
Provider Enumeration Date:
11/07/2005

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:  35077196 , 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: 22639 . This is a "QUALCHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 101425 . This is a "BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341960347 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341960347A . This is a "AULTCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 174396 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1962238 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 340960347 . This is a "SUMMA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000213674 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 104450 . This is a "KAISER PERMANENTE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341960347027 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2187271 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341960347 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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