Healthcare Provider Details

I. General information

NPI: 1154491819
Provider Name (Legal Business Name): SAMMY KHATIB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HIGHWAY
NEW ORLEANS LA
70121
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3151
  • Fax:
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberTRN10078
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD15198R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: