Healthcare Provider Details

I. General information

NPI: 1619951290
Provider Name (Legal Business Name): ARIF KHALIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 FIR ST UNIT 320
EAST CHICAGO IN
46312-3076
US

IV. Provider business mailing address

4320 FIR ST UNIT 320
EAST CHICAGO IN
46312-3076
US

V. Phone/Fax

Practice location:
  • Phone: 219-392-7992
  • Fax: 219-392-7987
Mailing address:
  • Phone: 219-392-7992
  • Fax: 219-392-7987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036-100068
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0100384A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01050384A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036-100068
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01050384A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: