Healthcare Provider Details

I. General information

NPI: 1700867959
Provider Name (Legal Business Name): AMIN YOUSSEF KHALIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSEPH A KHALIL M.D.

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 W MAPLE ST HARTVILLE
HARTVILLE OH
44632-9668
US

IV. Provider business mailing address

855 W MAPLE ST HARTVILLE
HARTVILLE OH
44632-9668
US

V. Phone/Fax

Practice location:
  • Phone: 330-877-9388
  • Fax: 330-488-2907
Mailing address:
  • Phone: 330-877-9388
  • Fax: 330-488-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35077196
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: