Healthcare Provider Details

I. General information

NPI: 1053387761
Provider Name (Legal Business Name): KHALEEL DEEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 NORTHCLIFF AVE SUITE 304
BROOKLYN OH
44144-3267
US

IV. Provider business mailing address

3535 LEE RD
SHAKER HEIGHTS OH
44120-5122
US

V. Phone/Fax

Practice location:
  • Phone: 216-749-8265
  • Fax: 216-749-8222
Mailing address:
  • Phone: 216-417-6166
  • Fax: 216-417-8676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35060323D
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: