Healthcare Provider Details

I. General information

NPI: 1407429574
Provider Name (Legal Business Name): MHMTJAMIL ALKHALAF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N EWING ST
LANCASTER OH
43130-3372
US

IV. Provider business mailing address

401 N EWING ST
LANCASTER OH
43130-3372
US

V. Phone/Fax

Practice location:
  • Phone: 614-663-4550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.151587
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: