MEDICARE: HARTVILLE INTERNAL MEDICINE PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101425	OTHER	OH	BLACK LUNG
2	000000213674	OTHER	OH	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518948702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARTVILLE INTERNAL MEDICINE PA

Provider Business Mailing Address
First Line	:	855 W MAPLE ST
Second Line	:	SUITE 130
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9668
Country	:	US
Telephone Number	:	330-877-9388
Fax Number	:	330-488-2907

Provider Business Practice Location Address
First Line	:	855 W MAPLE ST
Second Line	:	SUITE 130
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9668
Country	:	US
Telephone Number	:	330-877-9388
Fax Number	:	330-488-2907

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMIN YOUSSEF KHALIL
Credential	:	M.D.
Telephone Number	:	330-877-9388

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	05/02/2012

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Directions to “HARTVILLE INTERNAL MEDICINE PA ” Practice Location

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