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1316946098

NPI Code Detail

MEDICARE: MOUNIR B ELKHATIB MD

MEDICARE: MOUNIR B ELKHATIB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35036107	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000141182	OTHER	OH	ANTHEM
2	00221	OTHER	OH	PARAMOUNT
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0633287	OTHER	OH	AETNA
5	110176061	OTHER	OH	RRMC
6	04-03080	OTHER	OH	UHC

General Provider Information

NPI Number	:	1316946098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOUNIR B ELKHATIB MD

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

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

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	05/20/2010

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Directions to “ MOUNIR B ELKHATIB MD” Practice Location

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