Healthcare Provider Details

I. General information

NPI: 1457913121
Provider Name (Legal Business Name): MR. HAMAM ALKHATIB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 NAVARRE AVE STE F
OREGON OH
43616-3301
US

IV. Provider business mailing address

3316 NAVARRE AVE STE F
OREGON OH
43616-3301
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-1420
  • Fax: 419-214-3841
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025084
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: